Provider Demographics
NPI:1982445045
Name:NAKHLA, MARYAM (RPH)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:NAKHLA
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 1:190 W 54TH ST APT 213
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3298
Mailing Address - Country:US
Mailing Address - Phone:917-960-5384
Mailing Address - Fax:
Practice Address - Street 1:2395 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1909
Practice Address - Country:US
Practice Address - Phone:201-333-4092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04373300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist