Provider Demographics
NPI:1184893117
Name:MI ENTERPRISES LLC
Entity type:Organization
Organization Name:MI ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:MARVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JULY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:741-527-6078
Mailing Address - Street 1:8575 KNOTT AVE
Mailing Address - Street 2:STE D
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3850
Mailing Address - Country:US
Mailing Address - Phone:714-527-6078
Mailing Address - Fax:714-527-7185
Practice Address - Street 1:8575 KNOTT AVE
Practice Address - Street 2:STE D
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3850
Practice Address - Country:US
Practice Address - Phone:714-527-6078
Practice Address - Fax:714-527-7185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY486753336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5630872OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5630872OtherNCPDP PROVIDER IDENTIFICATION NUMBER