Provider Demographics
NPI:1558837898
Name:MILLAD-AZIZ, MINA SAMY (RPH)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:SAMY
Last Name:MILLAD-AZIZ
Suffix:
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 1:1064 ROCKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4925
Mailing Address - Country:US
Mailing Address - Phone:347-838-1614
Mailing Address - Fax:
Practice Address - Street 1:1064 ROCKLAND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4925
Practice Address - Country:US
Practice Address - Phone:347-838-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist