Provider Demographics
NPI:1417197187
Name:MIELNIK, JONA
Entity Type:Individual
Prefix:MS
First Name:JONA
Middle Name:
Last Name:MIELNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8302 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1224
Mailing Address - Country:US
Mailing Address - Phone:718-296-2153
Mailing Address - Fax:
Practice Address - Street 1:8302 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1224
Practice Address - Country:US
Practice Address - Phone:718-296-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01668895Medicaid
NY049928OtherPHARMACIST LICENSE