Provider Demographics
NPI:1982733366
Name:JOHN, MINNIE K (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MINNIE
Middle Name:K
Last Name:JOHN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3615
Mailing Address - Country:US
Mailing Address - Phone:201-385-6262
Mailing Address - Fax:
Practice Address - Street 1:20 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-3615
Practice Address - Country:US
Practice Address - Phone:201-385-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02448500183500000X
NJ28RI0248500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist