Healthcare Provider Details

I. General information

NPI: 1063852689
Provider Name (Legal Business Name): MIJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ANDREWS AVE
OZARK AL
36360-3726
US

IV. Provider business mailing address

2812 HARTFORD HWY SUITE 1
DOTHAN AL
36305-4927
US

V. Phone/Fax

Practice location:
  • Phone: 334-350-3671
  • Fax: 334-350-3672
Mailing address:
  • Phone: 334-699-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number202623
License Number StateAL

VIII. Authorized Official

Name: SHAKIR MEGHANI
Title or Position: OWNER
Credential:
Phone: 334-718-9768