Provider Demographics
NPI:1851906721
Name:MABROUK, HISHAM
Entity Type:Individual
Prefix:
First Name:HISHAM
Middle Name:
Last Name:MABROUK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 US HIGHWAY 206
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-2566
Mailing Address - Country:US
Mailing Address - Phone:908-396-7000
Mailing Address - Fax:
Practice Address - Street 1:1560 US HIGHWAY 206
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-2566
Practice Address - Country:US
Practice Address - Phone:908-396-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI033299700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist