Provider Demographics
NPI:1982453775
Name:YUSSOUF, MAHWISH ASIF
Entity type:Individual
Prefix:
First Name:MAHWISH
Middle Name:ASIF
Last Name:YUSSOUF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LENAPE DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4647
Mailing Address - Country:US
Mailing Address - Phone:732-422-6889
Mailing Address - Fax:
Practice Address - Street 1:3191 NJ-27
Practice Address - Street 2:STORE 3
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-4647
Practice Address - Country:US
Practice Address - Phone:732-798-6076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RJ14958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist