Provider Demographics
NPI:1477795524
Name:SALEH, MAYYADA (RPH)
Entity Type:Individual
Prefix:
First Name:MAYYADA
Middle Name:
Last Name:SALEH
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 1:28 MANCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3304
Mailing Address - Country:US
Mailing Address - Phone:973-696-1501
Mailing Address - Fax:212-529-2390
Practice Address - Street 1:28 MANCHESTER CT
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3304
Practice Address - Country:US
Practice Address - Phone:973-696-1501
Practice Address - Fax:212-529-2390
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01686479Medicaid