Provider Demographics
NPI:1376091678
Name:TOMA, MINA
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:TOMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BOSTON TPKE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-5223
Mailing Address - Country:US
Mailing Address - Phone:508-756-4201
Mailing Address - Fax:508-799-9362
Practice Address - Street 1:225 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-5223
Practice Address - Country:US
Practice Address - Phone:508-756-4201
Practice Address - Fax:508-799-9362
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist