Organization
MIRACLE PHARMACY INC
Active
Other names
Family pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
FOZIA MIRZA (PHARMACIST)
(201) 410-6995
Entity
Organization
Contact information
Practice address
9622 METROPOLITAN AVE, FOREST HILLS, NY 11375-6625
(718) 268-2151
Mailing address
9622 METROPOLITAN AVE, FOREST HILLS, NY 11375-6625
(718) 268-2151
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
048579-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
740850001
PTAN
NY
Enumeration date
03/02/2015
Last updated
12/29/2015
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