Healthcare Provider Details

I. General information

NPI: 1447947668
Provider Name (Legal Business Name): BARBY MINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SNYDER AVE
PHILADELPHIA PA
19148-2700
US

IV. Provider business mailing address

10 SNYDER AVE
PHILADELPHIA PA
19148-2700
US

V. Phone/Fax

Practice location:
  • Phone: 215-465-3270
  • Fax:
Mailing address:
  • Phone: 215-465-3270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number10072861
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: