Mill Park Drugs Inc

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

036468 Issued in NY

Legal business name

MILL PARK DRUGS INC

Practice address

3948 Richmond Ave
Staten Island, NY 10312-5111

Phone

(718) 356-1789

Fax

(718) 356-1777

NPI assigned

Feb 9, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Silvana Mattioli

Title

Owner/Ao

Phone

(718) 356-1789

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Eltingville Pharmacy Toys & Gifts Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524700800000",
    "number": "1669971172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3948 RICHMOND AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103125111",
            "telephone_number": "718-356-1789",
            "fax_number": "718-356-1777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3948 RICHMOND AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103125111",
            "telephone_number": "718-356-1789",
            "fax_number": "718-356-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILL PARK DRUGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-09",
        "last_updated": "2018-04-26",
        "status": "A",
        "authorized_official_last_name": "MATTIOLI",
        "authorized_official_first_name": "SILVANA",
        "authorized_official_title_or_position": "OWNER/AO",
        "authorized_official_telephone_number": "718-356-1789"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NY",
            "license": "036468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00337471",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2176079",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eltingville Pharmacy Toys & Gifts",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Charles Anthony Millan, MS, P.T.
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• Compounding Pharmacy in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Compounding Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.