Provider Demographics
NPI:1558842021
Name:DAWA PHARMACY LLC
Entity Type:Organization
Organization Name:DAWA PHARMACY LLC
Other - Org Name:DAWA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOUSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-925-5004
Mailing Address - Street 1:70 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2016
Mailing Address - Country:US
Mailing Address - Phone:973-925-5004
Mailing Address - Fax:
Practice Address - Street 1:70 BROWN AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:NJ
Practice Address - Zip Code:07508-2016
Practice Address - Country:US
Practice Address - Phone:973-925-5004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007666003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy