Organization
ST MINA INC
Active
Other names
ST MINA PHARMACY AND HOME CARE
Organization subpart
No
Provider details
NPI number
Authorized official
NADER ABADIER (PIC/ SECRETERY)
(909) 851-0311
Entity
Organization
Contact information
Practice address
16701 VALLEY BLVD STE E, FONTANA, CA 92335-6696
(909) 823-2515
(909) 823-2514
Mailing address
7643 CABRILLO WAY, EASTVALE, CA 92880-0923
(951) 738-9664
(909) 350-3223
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY52557
CA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801290440
—
CA
01
—
2148250
PK
—
Enumeration date
10/10/2014
Last updated
03/06/2017
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