Provider Demographics
NPI:1851835177
Name:THE MITRY GROUP INC
Entity Type:Organization
Organization Name:THE MITRY GROUP INC
Other - Org Name:MITRY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PIC
Authorized Official - Prefix:
Authorized Official - First Name:SHIRIF
Authorized Official - Middle Name:
Authorized Official - Last Name:MITRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD,MBA
Authorized Official - Phone:540-818-2229
Mailing Address - Street 1:145 E DUARTE RD STE D
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-6691
Mailing Address - Country:US
Mailing Address - Phone:626-317-5052
Mailing Address - Fax:626-317-5091
Practice Address - Street 1:145 E DUARTE RD STE D
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-6691
Practice Address - Country:US
Practice Address - Phone:626-317-5052
Practice Address - Fax:626-317-5091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BN1400X, 333600000X, 3336C0004X, 3336H0001X, 3336L0003X, 3336S0011X
CAPHY552853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166732OtherPK