Healthcare Provider Details

I. General information

NPI: 1649849183
Provider Name (Legal Business Name): MNK PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2021
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4184 BEYER BLVD STE 101
SAN YSIDRO CA
92173-2183
US

IV. Provider business mailing address

4184 BEYER BLVD STE 101
SAN YSIDRO CA
92173-2183
US

V. Phone/Fax

Practice location:
  • Phone: 619-207-0406
  • Fax: 619-271-3370
Mailing address:
  • Phone: 619-207-0406
  • Fax: 619-271-3370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. MIKE NAJAH KATY
Title or Position: OWNER
Credential: DR
Phone: 248-255-1058