Provider Demographics
NPI:1780440222
Name:MUKTA LLC
Entity type:Organization
Organization Name:MUKTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-210-1811
Mailing Address - Street 1:1103 N MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-1336
Mailing Address - Country:US
Mailing Address - Phone:864-210-1811
Mailing Address - Fax:864-210-1810
Practice Address - Street 1:1103 N MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:FOUNTAIN INN
Practice Address - State:SC
Practice Address - Zip Code:29644-1336
Practice Address - Country:US
Practice Address - Phone:864-210-1811
Practice Address - Fax:864-210-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy