MEDICARE: MBKO INC

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	3336C0003X	Community/Retail Pharmacy	28896	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2143189	OTHER		PK

General Provider Information

NPI Number	:	1780624569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MBKO INC

Provider Business Mailing Address
First Line	:	1610 MAIN ST
Second Line	:
City	:	JUNCTION
State	:	TX
Zip	:	76849-3518
Country	:	US
Telephone Number	:	325-446-2511
Fax Number	:	325-446-3889

Provider Business Practice Location Address
First Line	:	1610 MAIN ST
Second Line	:
City	:	JUNCTION
State	:	TX
Zip	:	76849-3518
Country	:	US
Telephone Number	:	325-446-2511
Fax Number	:	325-446-3889

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HYONBO KO
Credential	:
Telephone Number	:	325-446-2511

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	11/29/2016

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Directions to “MBKO INC ” Practice Location

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