Healthcare Provider Details

I. General information

NPI: 1053671800
Provider Name (Legal Business Name): MISHNIK PHARMACY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 SEQUOIA AVE SUITE 3
SIMI VALLEY CA
93063-3176
US

IV. Provider business mailing address

PO BOX 940816
SIMI VALLEY CA
93094-0816
US

V. Phone/Fax

Practice location:
  • Phone: 805-416-8900
  • Fax: 805-823-7767
Mailing address:
  • Phone: 805-258-6569
  • Fax: 805-823-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50179
License Number StateCA

VIII. Authorized Official

Name: MR. AMGAD MOHSEN MASIH
Title or Position: CHIEF PHARMACIST
Credential: RPH
Phone: 805-258-6569