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General NPI Number Information
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NPI Number | 1669743043
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Entity Type | Individual
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Provider Name | PAUL MINA PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 34-54 JUNCTION BLV
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372
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Country | US
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Telephone | 718-565-1005
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Fax | 718-565-1004
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Provider Business Mailing Address
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Address Line | 427 DANBURY LN
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-5116
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Country | US
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Telephone | 732-613-1459
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Fax | 732-613-0159
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 055819-1
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License Number State | NY
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