Provider Demographics
NPI:1346639259
Name:FARAJ, MUSTAFA (BS,PHARMD,RPH)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:FARAJ
Suffix:
Gender:M
Credentials:BS,PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 CAROL PL
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2926
Mailing Address - Country:US
Mailing Address - Phone:973-519-2624
Mailing Address - Fax:
Practice Address - Street 1:80 CAROL PL
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2926
Practice Address - Country:US
Practice Address - Phone:973-519-2624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI036817001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist