Provider Demographics
NPI:1316220569
Name:FARAG, MAGED (RPH)
Entity Type:Individual
Prefix:
First Name:MAGED
Middle Name:
Last Name:FARAG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1982 ROUTE 57
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-3470
Mailing Address - Country:US
Mailing Address - Phone:908-850-3529
Mailing Address - Fax:
Practice Address - Street 1:1982 ROUTE 57
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-3470
Practice Address - Country:US
Practice Address - Phone:908-850-3529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02911900183500000X
PARP442489183500000X
NY052443-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist