Provider Demographics
NPI:1760664908
Name:ASHAMALLA, ASHRAF (RPH)
Entity Type:Individual
Prefix:
First Name:ASHRAF
Middle Name:
Last Name:ASHAMALLA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:ASHRAF
Other - Middle Name:ESHAK
Other - Last Name:ASHAMALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:101 DUTCH RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2507
Mailing Address - Country:US
Mailing Address - Phone:201-993-0978
Mailing Address - Fax:201-339-1144
Practice Address - Street 1:651 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4710
Practice Address - Country:US
Practice Address - Phone:201-339-1200
Practice Address - Fax:201-339-1144
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI028217183500000X
NY046995-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY046995-1OtherSTATE LICENSE
NJ28RI028217OtherSTATE LICENSE