Provider Demographics
NPI:1053058842
Name:MENWER, ODAIE NOOFAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ODAIE
Middle Name:NOOFAN
Last Name:MENWER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 CHALADAY LN
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4917
Mailing Address - Country:US
Mailing Address - Phone:218-790-3632
Mailing Address - Fax:
Practice Address - Street 1:2151 JOHNSTON PL
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3608
Practice Address - Country:US
Practice Address - Phone:516-378-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist