Provider Demographics
NPI:1982229548
Name:MORKOS, MINA
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:MORKOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15707 CARPARZO DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-6715
Mailing Address - Country:US
Mailing Address - Phone:714-924-5645
Mailing Address - Fax:
Practice Address - Street 1:715 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-4129
Practice Address - Country:US
Practice Address - Phone:714-924-5645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist