Provider Demographics
NPI:1265652820
Name:MINI, JOHN VINCENT JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:VINCENT
Last Name:MINI
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 SARAH CIR
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3068
Mailing Address - Country:US
Mailing Address - Phone:603-524-8685
Mailing Address - Fax:
Practice Address - Street 1:724 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2742
Practice Address - Country:US
Practice Address - Phone:603-524-5064
Practice Address - Fax:603-527-2793
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR0869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist