Healthcare Provider Details

I. General information

NPI: 1316807118
Provider Name (Legal Business Name): IVAN MEJIA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 NORTHERN BLVD
JACKSON HEIGHTS NY
11372-1674
US

IV. Provider business mailing address

9710 38TH AVE
CORONA NY
11368-2135
US

V. Phone/Fax

Practice location:
  • Phone: 718-426-2508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073451
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: