Provider Demographics
NPI:1144073008
Name:MINO'S PHARMACY INC.
Entity type:Organization
Organization Name:MINO'S PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:QUINN JOHNSON
Authorized Official - Last Name:MINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-219-9888
Mailing Address - Street 1:13034 SHRINERS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-8250
Mailing Address - Country:US
Mailing Address - Phone:228-219-9888
Mailing Address - Fax:
Practice Address - Street 1:13034 SHRINERS BLVD STE A
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-8250
Practice Address - Country:US
Practice Address - Phone:228-219-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy