MEDICARE: MKA PHARMACY CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	PHY48298	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5625011	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689730954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MKA PHARMACY CORPORATION

Provider Business Mailing Address
First Line	:	14571 MAGNOLIA ST
Second Line	:	STE 104
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-5574
Country	:	US
Telephone Number	:	714-893-2697
Fax Number	:	714-893-3897

Provider Business Practice Location Address
First Line	:	14571 MAGNOLIA ST
Second Line	:	STE 104
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-5574
Country	:	US
Telephone Number	:	714-893-2697
Fax Number	:	714-893-3897

Authorized Official
Title or Position	:	CEO
Name	:	KEVIN HOANG DINH
Credential	:	PHARM.D.
Telephone Number	:	714-893-2697

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	11/13/2024

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Directions to “MKA PHARMACY CORPORATION ” Practice Location

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