Provider Demographics
NPI:1972862522
Name:HASSELMAN, QUEILA
Entity Type:Individual
Prefix:
First Name:QUEILA
Middle Name:
Last Name:HASSELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:QUEILA
Other - Middle Name:
Other - Last Name:CHAVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:195 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-3921
Mailing Address - Country:US
Mailing Address - Phone:973-824-8664
Mailing Address - Fax:
Practice Address - Street 1:195 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3921
Practice Address - Country:US
Practice Address - Phone:973-824-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03479000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist