Organization
MIKMARA INC
Active
Other names
ALLEN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KIM PHUNG (OWNER)
(619) 708-1797
Entity
Organization
Contact information
Practice address
333 C ST STE 100, SAN DIEGO, CA 92101-4809
(619) 232-8101
(619) 232-8855
Mailing address
333 C ST STE 100, SAN DIEGO, CA 92101-4809
(619) 232-8101
(619) 232-8855
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY48339
CA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992766
PK
—
Enumeration date
12/26/2006
Last updated
11/24/2020
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