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General NPI Number Information
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NPI Number | 1881720985
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Entity Type | Organization
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Legal Business Name | M.M.J.J. INC.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 64 CARLETON AVE STE B
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City | ISLIP TERRACE
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State | NY
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Zip | 11752-1500
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Country | US
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Telephone | 631-277-9515
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Fax | 631-277-7844
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Provider Business Mailing Address
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Address Line | 64 CARLETON AVE STE B
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City | ISLIP TERRACE
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State | NY
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Zip | 11752-1500
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Country | US
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Telephone | 631-277-9515
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Fax | 631-277-7844
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK C. GOLDSTEIN
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Credential |
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Telephone | 631-277-9515
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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 | 017707
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License Number State | NY
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