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General NPI Number Information
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NPI Number | 1184022188
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Entity Type | Organization
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Legal Business Name | MINTWOOD PHARMACUETICALS, INC.
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 455 N LAKE AVE
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City | PASADENA
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State | CA
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Zip | 91101
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Country | US
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Telephone | 626-314-2945
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Fax | 626-314-2944
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Provider Business Mailing Address
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Address Line | 455 N LAKE AVE
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City | PASADENA
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State | CA
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Zip | 91101-1215
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Country | US
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Telephone | 626-314-2945
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Fax | 626-314-2944
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Authorized Official
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Title or Position | VICE PRESIDENT & PIC
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Name | NANCY ELIAS
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Credential |
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Telephone | 626-314-2945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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