Provider Demographics
NPI:1265574149
Name:M&I ENTERPRISES,INC
Entity type:Organization
Organization Name:M&I ENTERPRISES,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAT(MAN)
Authorized Official - Middle Name:Y
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:626-791-7595
Mailing Address - Street 1:2750 E-WASHINGTON BLVD.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107
Mailing Address - Country:US
Mailing Address - Phone:626-791-7595
Mailing Address - Fax:626-791-3564
Practice Address - Street 1:2750 E-WASHINGTON BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107
Practice Address - Country:US
Practice Address - Phone:626-791-7595
Practice Address - Fax:626-791-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0581872OtherNABP NUMBER
CABS0693095OtherD.E.A NUMBER
CAPHY36557OtherPHARMACY PERMIT NUMBER
CAPHA365570Medicaid
CAPHA365570Medicaid