Healthcare Provider Details

I. General information

NPI: 1396827192
Provider Name (Legal Business Name): MIV INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 MAIN ST
FREELAND PA
18224-1915
US

IV. Provider business mailing address

PO BOX G
FREELAND PA
18224-0560
US

V. Phone/Fax

Practice location:
  • Phone: 570-636-0480
  • Fax: 570-636-0508
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP481528
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP481528
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPP481528
License Number StatePA

VIII. Authorized Official

Name: ANGELO GRECO
Title or Position: PRESIDENT
Credential: RPH
Phone: 570-455-8081