Healthcare Provider Details

I. General information

NPI: 1649824020
Provider Name (Legal Business Name): MINA N SOLIMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 RICHMOND AVE
STATEN ISLAND NY
10314-3903
US

IV. Provider business mailing address

68 VILLANOVA ST
STATEN ISLAND NY
10314-6032
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-0500
  • Fax:
Mailing address:
  • Phone: 646-236-4507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number065507
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number065507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: