Provider Demographics
NPI:1154046654
Name:GIRGIS, MINA ATEF (RPH)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:ATEF
Last Name:GIRGIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 MAPLE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1319
Mailing Address - Country:US
Mailing Address - Phone:570-202-5465
Mailing Address - Fax:
Practice Address - Street 1:700 BROAD ST
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:NJ
Practice Address - Zip Code:08077-1145
Practice Address - Country:US
Practice Address - Phone:570-202-5465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04173600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist