Provider Demographics
NPI:1730750829
Name:MISTFLOWER EXPRESS LLC.
Entity type:Organization
Organization Name:MISTFLOWER EXPRESS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/DRIVER
Authorized Official - Prefix:
Authorized Official - First Name:HAIDER
Authorized Official - Middle Name:RADHI
Authorized Official - Last Name:AL KINANI
Authorized Official - Suffix:
Authorized Official - Credentials:PROVIDER
Authorized Official - Phone:210-284-8219
Mailing Address - Street 1:10501 MISTFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3737
Mailing Address - Country:US
Mailing Address - Phone:210-284-8219
Mailing Address - Fax:
Practice Address - Street 1:10501 MISTFLOWER LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3737
Practice Address - Country:US
Practice Address - Phone:210-284-8219
Practice Address - Fax:813-428-6772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date: