Provider Demographics
NPI:1013529452
Name:MAFARJEH, WACAS MOUSA (PHARM D)
Entity Type:Individual
Prefix:
First Name:WACAS
Middle Name:MOUSA
Last Name:MAFARJEH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-1815
Mailing Address - Country:US
Mailing Address - Phone:908-590-4582
Mailing Address - Fax:
Practice Address - Street 1:508 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2207
Practice Address - Country:US
Practice Address - Phone:973-672-6317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03968600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist