Organization
MINTWOOD PHARMACUETICALS, INC.
Active
Organization
MINTWOOD PHARMACUETICALS, INC.
Active
Other names
Mintwood Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY ELIAS (VICE PRESIDENT & PIC)
(626) 314-2945
Entity
Organization
Contact information
Practice address
455 N LAKE AVE, PASADENA, CA 91101
(626) 314-2945
(626) 314-2944
Mailing address
455 N LAKE AVE, PASADENA, CA 91101-1215
(626) 314-2945
(626) 314-2944
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY56896
STATE LICENSE PERMIT
CA
Enumeration date
12/08/2014
Last updated
01/18/2019
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