=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902134083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KOTANATIONAL MERCANTILE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2009
-----------------------------------------------------
Last Update Date | 11/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 128 NE 54TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33137-2416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-751-2783
-----------------------------------------------------
Fax | 305-758-3522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 128 NE 54TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33137-2416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-751-2783
-----------------------------------------------------
Fax | 305-758-3522
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TONY F ORUKOTAN
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 305-751-2783
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH11215
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------