Provider Demographics
NPI:1891165148
Name:KAMAL, MUSTAFA (RPH)
Entity Type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:KAMAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5052
Mailing Address - Country:US
Mailing Address - Phone:716-983-6984
Mailing Address - Fax:
Practice Address - Street 1:1985 SWARTHMORE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4554
Practice Address - Country:US
Practice Address - Phone:732-597-6000
Practice Address - Fax:732-328-2224
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03115000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist