Provider Demographics
NPI:1871815787
Name:GOLD, MINA (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:MINA
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 BERNHARDT DR
Mailing Address - Street 2:APT 4
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4733
Mailing Address - Country:US
Mailing Address - Phone:716-697-4759
Mailing Address - Fax:
Practice Address - Street 1:1070 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-3007
Practice Address - Country:US
Practice Address - Phone:716-894-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052820-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist