Provider Demographics
NPI:1902479207
Name:BISHARA, REMON Y (RPH)
Entity type:Individual
Prefix:
First Name:REMON
Middle Name:Y
Last Name:BISHARA
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 1:328 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3520
Mailing Address - Country:US
Mailing Address - Phone:201-356-7752
Mailing Address - Fax:201-471-2411
Practice Address - Street 1:BROADWAY HEALTH PHARMACY
Practice Address - Street 2:974 BROADWAY
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:201-471-2400
Practice Address - Fax:201-471-2411
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI0378000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist