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General NPI Number Information
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NPI Number | 1346632395
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Entity Type | Organization
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Legal Business Name | MIMIKAY PHARMACY
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 06/07/2015
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Provider Practice Location Address
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Address Line | 1027 W 36TH ST
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City | BALTIMORE
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State | MD
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Zip | 21211-2416
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Country | US
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Telephone | 410-469-9206
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Fax | 410-469-9243
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Provider Business Mailing Address
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Address Line | 1027 W 36TH ST
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City | BALTIMORE
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State | MD
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Zip | 21211-2416
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Country | US
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Telephone | 410-469-9206
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Fax | 410-469-9243
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Authorized Official
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Title or Position | PHARMACY OWNER
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Name | JOANITTA ESTHER BEDIAKO
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Credential | PHARMD
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Telephone | 703-953-7736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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