Provider Demographics
NPI:1568757615
Name:DARUWALA, FARHAD
Entity Type:Individual
Prefix:
First Name:FARHAD
Middle Name:
Last Name:DARUWALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-1173
Mailing Address - Country:US
Mailing Address - Phone:201-252-8456
Mailing Address - Fax:
Practice Address - Street 1:2075 HAMBURG TPKE STE 2A
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6293
Practice Address - Country:US
Practice Address - Phone:973-513-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02778800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist