Provider Demographics
NPI:1184335457
Name:BOULARES, MOUNA
Entity type:Individual
Prefix:
First Name:MOUNA
Middle Name:
Last Name:BOULARES
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 1:266 7TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6937
Mailing Address - Country:US
Mailing Address - Phone:551-233-3457
Mailing Address - Fax:
Practice Address - Street 1:75 MARKET ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1246
Practice Address - Country:US
Practice Address - Phone:973-684-6991
Practice Address - Fax:973-684-6993
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04287100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist