Provider Demographics
NPI:1639876493
Name:MOHAMMAD, NIDA HAYAT
Entity Type:Individual
Prefix:
First Name:NIDA
Middle Name:HAYAT
Last Name:MOHAMMAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2601
Mailing Address - Country:US
Mailing Address - Phone:908-206-7450
Mailing Address - Fax:
Practice Address - Street 1:603 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2601
Practice Address - Country:US
Practice Address - Phone:908-206-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04280100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist