Healthcare Provider Details

I. General information

NPI: 1124600432
Provider Name (Legal Business Name): MIO PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S MORENCI AVE
MIO MI
48647-2509
US

IV. Provider business mailing address

PO BOX 1150
AU GRES MI
48703-1150
US

V. Phone/Fax

Practice location:
  • Phone: 989-876-8899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: TERESA JEAN SPIES
Title or Position: MEMBER
Credential:
Phone: 989-876-8899