Provider Demographics
NPI:1699299479
Name:SIYAM, MOHANNAD (RPH)
Entity type:Individual
Prefix:
First Name:MOHANNAD
Middle Name:
Last Name:SIYAM
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 1:601 4TH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2818
Mailing Address - Country:US
Mailing Address - Phone:856-473-3955
Mailing Address - Fax:
Practice Address - Street 1:601 4TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2818
Practice Address - Country:US
Practice Address - Phone:856-473-3955
Practice Address - Fax:856-473-3976
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03839800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist