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General NPI Number Information
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NPI Number | 1447534573
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Entity Type | Organization
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Legal Business Name | ST MINA INC
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 8110 MANGO AVE STE 105
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City | FONTANA
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State | CA
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Zip | 92335-3603
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Country | US
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Telephone | 909-350-3200
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Fax | 909-350-3223
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Provider Business Mailing Address
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Address Line | 7643 CABRILLO WAY
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City | EASTVALE
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State | CA
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Zip | 92880-0923
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Country | US
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Telephone | 909-350-3200
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Fax | 909-350-3223
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Authorized Official
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Title or Position | SECRETARY/PHARMACIST
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Name | NADER ABADIER
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Credential |
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Telephone | 909-851-0311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 50685
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License Number State | CA
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