Healthcare Provider Details

I. General information

NPI: 1215076260
Provider Name (Legal Business Name): MIKU PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/19/2025
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26902 OSO PKWY STE 160
MISSION VIEJO CA
92691-5801
US

IV. Provider business mailing address

26902 OSO PKWY STE 160
MISSION VIEJO CA
92691-5801
US

V. Phone/Fax

Practice location:
  • Phone: 949-582-3633
  • Fax: 949-582-8264
Mailing address:
  • Phone: 949-582-3633
  • Fax: 949-582-8264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY53671
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMANDA TA
Title or Position: OWNER
Credential:
Phone: 949-582-3633