Provider Demographics
NPI:1447428065
Name:BORHANI, MITRA (PHARM-D)
Entity Type:Individual
Prefix:
First Name:MITRA
Middle Name:
Last Name:BORHANI
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2787
Mailing Address - Country:US
Mailing Address - Phone:609-918-0511
Mailing Address - Fax:609-918-0510
Practice Address - Street 1:440 ROUTE 130
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2787
Practice Address - Country:US
Practice Address - Phone:609-918-0511
Practice Address - Fax:609-918-0510
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-17
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02729200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist