Organization
MICKEY FINE ENTERPRISES INC
Active
Organization
MICKEY FINE ENTERPRISES INC
Active
Other names
Mickey Fine Pharmacy & Snack Shop
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY GROSS (PRESIDENT)
(310) 277-6123
Entity
Organization
Contact information
Practice address
2000 AVENUE OF THE STARS, LOS ANGELES, CA 90067-4700
(310) 277-6123
(310) 277-6128
Mailing address
2000 AVENUE OF THE STARS, LOS ANGELES, CA 90067-4700
(310) 277-6123
(310) 277-6128
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY52590
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137937
PK
—
Enumeration date
12/10/2012
Last updated
04/27/2015
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