Provider Demographics
NPI:1649849183
Name:MNK PHARMACY LLC
Entity type:Organization
Organization Name:MNK PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:NAJAH
Authorized Official - Last Name:KATY
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:248-255-1058
Mailing Address - Street 1:4184 BEYER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-2183
Mailing Address - Country:US
Mailing Address - Phone:619-207-0406
Mailing Address - Fax:619-271-3370
Practice Address - Street 1:4184 BEYER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-2183
Practice Address - Country:US
Practice Address - Phone:619-207-0406
Practice Address - Fax:619-271-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-20
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy