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General NPI Number Information
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NPI Number | 1811018377
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Entity Type | Organization
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Legal Business Name | MINA PHARMACY CORP
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 875 BERGEN AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07306-4405
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Country | US
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Telephone | 201-792-9881
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Fax | 201-792-9882
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Provider Business Mailing Address
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Address Line | 875 BERGEN AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07306-4405
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Country | US
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Telephone | 201-792-9881
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Fax | 201-792-9882
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Authorized Official
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Title or Position | OWNER AND PHARMACIST
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Name | SAID MAKAR
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Credential |
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Telephone | 201-792-9881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00626300
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License Number State | NJ
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