Provider Demographics
NPI:1073895769
Name:JAVDAN, MARYAM (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:MARYAM
Middle Name:
Last Name:JAVDAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1357
Mailing Address - Country:US
Mailing Address - Phone:201-384-0964
Mailing Address - Fax:201-387-0154
Practice Address - Street 1:241 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1357
Practice Address - Country:US
Practice Address - Phone:201-384-0964
Practice Address - Fax:201-387-0154
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03152600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist