Provider Demographics
NPI:1760830806
Name:IJAZ, JAVERIA
Entity Type:Individual
Prefix:
First Name:JAVERIA
Middle Name:
Last Name:IJAZ
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 1:523 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2730
Mailing Address - Country:US
Mailing Address - Phone:917-396-2626
Mailing Address - Fax:
Practice Address - Street 1:1210 ROUTE 130 N
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3046
Practice Address - Country:US
Practice Address - Phone:917-396-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03750000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist