Healthcare Provider Details

I. General information

NPI: 1114917358
Provider Name (Legal Business Name): MISINKO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 ATLANTIC AVE
CUDAHY CA
90201-5019
US

IV. Provider business mailing address

7611 ATLANTIC AVE
CUDAHY CA
90201-5019
US

V. Phone/Fax

Practice location:
  • Phone: 323-773-1700
  • Fax: 323-773-5959
Mailing address:
  • Phone: 323-773-1700
  • Fax: 323-773-5959

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 NumberPHY43282
License Number StateCA

VIII. Authorized Official

Name: PRATISH MISTRY
Title or Position: TREASURER
Credential: RPH
Phone: 323-773-1700