Healthcare Provider Details

I. General information

NPI: 1780624569
Provider Name (Legal Business Name): MBKO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 MAIN ST
JUNCTION TX
76849-3518
US

IV. Provider business mailing address

1610 MAIN ST
JUNCTION TX
76849-3518
US

V. Phone/Fax

Practice location:
  • Phone: 325-446-2511
  • Fax: 325-446-3889
Mailing address:
  • Phone: 325-446-2511
  • Fax: 325-446-3889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28896
License Number StateTX

VIII. Authorized Official

Name: HYONBO KO
Title or Position: PRESIDENT
Credential:
Phone: 325-446-2511