Active NPI
Mina Kwon, PHARMD
- Pharmacist
- Ronkonkoma, NY
National Provider Identifier
1619227865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 057213
- Practice address
- 65 Richmond Blvd Unit 3a
Ronkonkoma, NY 11779-3640 - Phone
- (917) 560-3466
- NPI assigned
- Sep 14, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 057213 | NY | Primary |
Addresses
Primary practice location
65 Richmond Blvd Unit 3a
Ronkonkoma, NY 11779-3640
Mailing address
2975 Horseblock Road
Medford, NY 11763
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057213 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347580800000",
"number": "1619227865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2975 HORSEBLOCK ROAD",
"city": "MEDFORD",
"state": "NY",
"postal_code": "11763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 RICHMOND BLVD UNIT 3A",
"city": "RONKONKOMA",
"state": "NY",
"postal_code": "117793640",
"telephone_number": "917-560-3466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWON",
"first_name": "MINA",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-14",
"last_updated": "2012-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "057213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ronkonkoma, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.