Provider Demographics
NPI:1366852568
Name:DANDASH, MOHAMED ADEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:ADEL
Last Name:DANDASH
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 1:8 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2702
Mailing Address - Country:US
Mailing Address - Phone:347-608-1675
Mailing Address - Fax:973-707-2692
Practice Address - Street 1:8 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2702
Practice Address - Country:US
Practice Address - Phone:347-608-1675
Practice Address - Fax:973-707-2692
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03599900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0369322Medicaid