Provider Demographics
NPI:1326702267
Name:SIDDIQUI, IMRANA (PHARMACISTS)
Entity Type:Individual
Prefix:
First Name:IMRANA
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:PHARMACISTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2358
Mailing Address - Country:US
Mailing Address - Phone:201-385-8883
Mailing Address - Fax:
Practice Address - Street 1:50 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2358
Practice Address - Country:US
Practice Address - Phone:201-385-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03197300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist