Provider Demographics
NPI:1427932920
Name:MIXWELL PHARMACY LLC
Entity type:Organization
Organization Name:MIXWELL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:THAI
Authorized Official - Last Name:PUNGPRAVAT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:626-688-5709
Mailing Address - Street 1:13788 ROSWELL AVE STE 158
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1409
Mailing Address - Country:US
Mailing Address - Phone:909-378-7301
Mailing Address - Fax:909-378-7071
Practice Address - Street 1:13788 ROSWELL AVE STE 158
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1409
Practice Address - Country:US
Practice Address - Phone:909-378-7301
Practice Address - Fax:909-378-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy