Provider Demographics
NPI:1699371229
Name:DAWOD, MERRY
Entity Type:Individual
Prefix:
First Name:MERRY
Middle Name:
Last Name:DAWOD
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 1:15 AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7747
Mailing Address - Country:US
Mailing Address - Phone:201-951-7862
Mailing Address - Fax:
Practice Address - Street 1:1001 ROUTE 70
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NJ
Practice Address - Zip Code:08759-5804
Practice Address - Country:US
Practice Address - Phone:732-657-0099
Practice Address - Fax:732-657-0033
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03020900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist