Provider Demographics
NPI:1679856207
Name:SARNAS, MALWINA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:MALWINA
Middle Name:
Last Name:SARNAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 PAVONIA AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2230
Mailing Address - Country:US
Mailing Address - Phone:201-889-2855
Mailing Address - Fax:
Practice Address - Street 1:67 PAVONIA AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2230
Practice Address - Country:US
Practice Address - Phone:201-889-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03287800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0211036Medicaid