Provider Demographics
NPI:1871866731
Name:HENNEN, WESAM
Entity Type:Individual
Prefix:
First Name:WESAM
Middle Name:
Last Name:HENNEN
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 1:9 MORRIS DR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3546
Mailing Address - Country:US
Mailing Address - Phone:732-679-0568
Mailing Address - Fax:732-656-9554
Practice Address - Street 1:900 SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-8617
Practice Address - Country:US
Practice Address - Phone:908-624-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02453600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist