Provider Demographics
NPI:1497498109
Name:BISHAI, MERNA S
Entity Type:Individual
Prefix:
First Name:MERNA
Middle Name:S
Last Name:BISHAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MERNA
Other - Middle Name:S
Other - Last Name:BISHAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:175 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2542
Mailing Address - Country:US
Mailing Address - Phone:973-759-4877
Mailing Address - Fax:
Practice Address - Street 1:175 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2542
Practice Address - Country:US
Practice Address - Phone:973-759-4877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04240000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist