Provider Demographics
NPI:1821392788
Name:NATIVIDAD, CARISSA ABANO (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:ABANO
Last Name:NATIVIDAD
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 1:4041 HADLEY RD STE M
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-1111
Mailing Address - Country:US
Mailing Address - Phone:800-793-8073
Mailing Address - Fax:
Practice Address - Street 1:4041 HADLEY RD STE M
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-1111
Practice Address - Country:US
Practice Address - Phone:800-793-8073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03375500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist