MEDICARE: MINA MINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	85870	CA

General Provider Information

NPI Number	:	1447990148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINA MINA

Provider Business Mailing Address
First Line	:	11715 PRIVET PL
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311-9336
Country	:	US
Telephone Number	:	661-573-5951
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 PANAMA LN UNIT 116
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93313-3481
Country	:	US
Telephone Number	:	661-836-7557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	03/30/2022

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Directions to “ MINA MINA ” Practice Location

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