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General NPI Number Information
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NPI Number | 1679517049
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Entity Type | Organization
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Legal Business Name | MIL-DAN, INC
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 11/08/2008
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Provider Practice Location Address
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Address Line | 215 N HERMITAGE AVE
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City | TRENTON
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State | NJ
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Zip | 08618-5511
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Country | US
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Telephone | 609-394-0600
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Fax | 609-394-5505
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Provider Business Mailing Address
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Address Line | 215 N HERMITAGE AVE
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City | TRENTON
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State | NJ
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Zip | 08618-5511
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Country | US
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Telephone | 609-394-0600
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Fax | 609-394-5505
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | MR. MILES K ETTMAN
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Credential | RPH
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Telephone | 609-394-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0125164
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00378900
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License Number State | NJ
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