Provider Demographics
NPI:1346298056
Name:MI FARMACIA LLC
Entity Type:Organization
Organization Name:MI FARMACIA LLC
Other - Org Name:GASTELL & LLOYD LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKELINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ARDON
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:201-325-8700
Mailing Address - Street 1:406 - 37TH ST.
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4804
Mailing Address - Country:US
Mailing Address - Phone:201-325-8700
Mailing Address - Fax:201-325-8702
Practice Address - Street 1:406 - 37TH ST.
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4804
Practice Address - Country:US
Practice Address - Phone:201-325-8700
Practice Address - Fax:201-325-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS006593003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3193579OtherNCPDP
3193579OtherNCPDP
NJRS00659300OtherSTATE PHARMACY LICENSE
NJ5654100001Medicare NSC