Provider Demographics
NPI:1942889324
Name:ABDELNOOR, MARYANNE G
Entity Type:Individual
Prefix:MRS
First Name:MARYANNE
Middle Name:G
Last Name:ABDELNOOR
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 1:327 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3704
Mailing Address - Country:US
Mailing Address - Phone:908-469-9653
Mailing Address - Fax:908-469-9655
Practice Address - Street 1:327 N BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3704
Practice Address - Country:US
Practice Address - Phone:908-469-9653
Practice Address - Fax:908-469-9655
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03993300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist