Organization
MINIMS APOTHECARY LLC, DBA BANETH'S PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SAGEDA MAHMOUD-THIRUCOTE (PHARMACIST - IN - CHARGE)
(650) 326-8400
Entity
Organization
Contact information
Practice address
900 WILLOW RD, MENLO PARK, CA 94025-2544
(650) 326-8400
(650) 323-2609
Mailing address
900 WILLOW RD, MENLO PARK, CA 94025-2544
(650) 326-8400
(650) 323-2609
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHY46536
CA
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PHY48368
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0523123
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
PHA465360
—
CA
Enumeration date
09/12/2006
Last updated
03/24/2009
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