Provider Demographics
NPI:1205217395
Name:HENEN, MERIT
Entity Type:Individual
Prefix:MISS
First Name:MERIT
Middle Name:
Last Name:HENEN
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 1:15 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2410
Mailing Address - Country:US
Mailing Address - Phone:201-566-4666
Mailing Address - Fax:
Practice Address - Street 1:67 SAINT GEORGE AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2916
Practice Address - Country:US
Practice Address - Phone:908-298-1304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03596100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist