Provider Demographics
NPI:1164010112
Name:YASSA, SHERIF
Entity Type:Individual
Prefix:
First Name:SHERIF
Middle Name:
Last Name:YASSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 COMMUNIPAW AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-3723
Mailing Address - Country:US
Mailing Address - Phone:201-685-7332
Mailing Address - Fax:201-685-7329
Practice Address - Street 1:381 COMMUNIPAW AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-3723
Practice Address - Country:US
Practice Address - Phone:201-685-7332
Practice Address - Fax:201-685-7329
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03712300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist