Provider Demographics
NPI:1588073514
Name:MAFLA, JENNIFER NATHALIE (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NATHALIE
Last Name:MAFLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:884 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2921
Mailing Address - Country:US
Mailing Address - Phone:908-403-3998
Mailing Address - Fax:
Practice Address - Street 1:2690 US HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-8512
Practice Address - Country:US
Practice Address - Phone:908-688-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03640300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist