Provider Demographics
NPI:1194588038
Name:FAHMY, MENATALLA F (RPH)
Entity type:Individual
Prefix:
First Name:MENATALLA
Middle Name:F
Last Name:FAHMY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-4592
Mailing Address - Country:US
Mailing Address - Phone:929-422-8962
Mailing Address - Fax:
Practice Address - Street 1:2933 VAUXHALL RD
Practice Address - Street 2:
Practice Address - City:VAUXHALL
Practice Address - State:NJ
Practice Address - Zip Code:07088-1260
Practice Address - Country:US
Practice Address - Phone:908-378-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04354200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist