Provider Demographics
NPI:1316368038
Name:ELHENNAWY, MOSTAFA M (RPH)
Entity Type:Individual
Prefix:DR
First Name:MOSTAFA
Middle Name:M
Last Name:ELHENNAWY
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 1:154 MERILINE AVE APT H
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3042
Mailing Address - Country:US
Mailing Address - Phone:201-682-4787
Mailing Address - Fax:
Practice Address - Street 1:711 BERGEN AVE
Practice Address - Street 2:NEW HORIZON PHARMACY
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4801
Practice Address - Country:US
Practice Address - Phone:201-324-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03459700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist