Provider Demographics
NPI:1992537849
Name:HENRY, MARIAM (RPH)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:HENRY
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 1:382 BELLEVILLE TPKE
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-6524
Mailing Address - Country:US
Mailing Address - Phone:201-279-0200
Mailing Address - Fax:201-279-0400
Practice Address - Street 1:382 BELLEVILLE TPKE
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-6524
Practice Address - Country:US
Practice Address - Phone:201-279-0200
Practice Address - Fax:201-279-0400
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03593200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist