Provider Demographics
NPI:1912253956
Name:MINEOLA FAMILY PHARMACY INC.
Entity Type:Organization
Organization Name:MINEOLA FAMILY PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NORONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-427-5573
Mailing Address - Street 1:182 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4021
Mailing Address - Country:US
Mailing Address - Phone:516-427-5573
Mailing Address - Fax:516-427-5574
Practice Address - Street 1:182 2ND ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4021
Practice Address - Country:US
Practice Address - Phone:516-427-5573
Practice Address - Fax:516-427-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0313973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100093900Medicare PIN