Provider Demographics
NPI:1407966757
Name:GIRGIS, MERVAT (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MERVAT
Middle Name:
Last Name:GIRGIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CASCADES AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731
Mailing Address - Country:US
Mailing Address - Phone:732-919-2372
Mailing Address - Fax:732-389-9022
Practice Address - Street 1:271 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757
Practice Address - Country:US
Practice Address - Phone:732-542-8607
Practice Address - Fax:832-389-9022
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02066600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9034706Medicaid
NJ9034706Medicaid