Provider Demographics
NPI:1972209369
Name:MEKHAEIL, EMAD
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:
Last Name:MEKHAEIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2349
Mailing Address - Country:US
Mailing Address - Phone:201-805-2802
Mailing Address - Fax:
Practice Address - Street 1:65 CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:UPPER SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-2349
Practice Address - Country:US
Practice Address - Phone:201-805-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04291100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist