Provider Demographics
NPI:1861885170
Name:MAKTINA LLC
Entity type:Organization
Organization Name:MAKTINA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KADOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-552-6054
Mailing Address - Street 1:4012 SAWYER RD
Mailing Address - Street 2:SUITE# 107
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1231
Mailing Address - Country:US
Mailing Address - Phone:941-552-6054
Mailing Address - Fax:
Practice Address - Street 1:4012 SAWYER RD
Practice Address - Street 2:SUITE# 107
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1231
Practice Address - Country:US
Practice Address - Phone:941-552-6054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH294853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013655600Medicaid