Healthcare Provider Details

I. General information

NPI: 1740724749
Provider Name (Legal Business Name): JAMES R MIELO R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 DAVIDSONS MILL RD
JAMESBURG NJ
08831-3014
US

IV. Provider business mailing address

355 DAVIDSONS MILL RD
JAMESBURG NJ
08831-3014
US

V. Phone/Fax

Practice location:
  • Phone: 732-521-8427
  • Fax:
Mailing address:
  • Phone: 732-521-8427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02347600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: