Provider Demographics
NPI:1134780786
Name:MINO'S PHARMACY INC.
Entity type:Organization
Organization Name:MINO'S PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:QUINN
Authorized Official - Last Name:MINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:228-219-9888
Mailing Address - Street 1:13034 SHRINERS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-8250
Mailing Address - Country:US
Mailing Address - Phone:228-392-5355
Mailing Address - Fax:228-392-1620
Practice Address - Street 1:13034 SHRINERS BLVD STE A
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-8250
Practice Address - Country:US
Practice Address - Phone:228-392-5355
Practice Address - Fax:228-392-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy