Provider Demographics
NPI:1700191392
Name:BORA, PARVIN ABDUL (RPH)
Entity Type:Individual
Prefix:
First Name:PARVIN
Middle Name:ABDUL
Last Name:BORA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RUSSETT RD
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1419
Mailing Address - Country:US
Mailing Address - Phone:732-940-8536
Mailing Address - Fax:732-545-2326
Practice Address - Street 1:841 GEORGES RD
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3359
Practice Address - Country:US
Practice Address - Phone:732-545-9487
Practice Address - Fax:732-545-2326
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02922100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist