Provider Demographics
NPI:1972310704
Name:ISTAFANOS, SHERIF W (RPH)
Entity type:Individual
Prefix:MR
First Name:SHERIF
Middle Name:W
Last Name:ISTAFANOS
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 1:89 BELGROVE DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1598
Mailing Address - Country:US
Mailing Address - Phone:732-900-8237
Mailing Address - Fax:
Practice Address - Street 1:89 BELGROVE DR APT 2A
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-1598
Practice Address - Country:US
Practice Address - Phone:732-900-8237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04415400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist