Provider Demographics
NPI:1417288515
Name:BARSOUM, NADAR A (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:NADAR
Middle Name:A
Last Name:BARSOUM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 CEDAR VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1381
Mailing Address - Country:US
Mailing Address - Phone:732-354-8202
Mailing Address - Fax:718-266-2289
Practice Address - Street 1:2001 BATH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4813
Practice Address - Country:US
Practice Address - Phone:718-266-2266
Practice Address - Fax:718-266-2289
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist