Provider Demographics
NPI:1104147412
Name:ABRAHAM, LIJU ELIZABETH
Entity type:Individual
Prefix:
First Name:LIJU
Middle Name:ELIZABETH
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 KASTLER CT
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1231
Mailing Address - Country:US
Mailing Address - Phone:201-742-3539
Mailing Address - Fax:
Practice Address - Street 1:654 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIVERVALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6256
Practice Address - Country:US
Practice Address - Phone:210-664-6900
Practice Address - Fax:201-664-9058
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03192800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist