Provider Demographics
NPI:1962771709
Name:FAILLA, SALLYANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:SALLYANN
Middle Name:
Last Name:FAILLA
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 1:5 AMAGANSETT DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1182
Mailing Address - Country:US
Mailing Address - Phone:732-972-8281
Mailing Address - Fax:
Practice Address - Street 1:703 GINESI DR
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1235
Practice Address - Country:US
Practice Address - Phone:732-617-8686
Practice Address - Fax:732-617-8321
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01617200183500000X
NY033476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist