Provider Demographics
NPI:1245512904
Name:GOLYAK, MARIANA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:
Last Name:GOLYAK
Suffix:
Gender:F
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 1:668 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-2420
Mailing Address - Country:US
Mailing Address - Phone:201-321-5709
Mailing Address - Fax:
Practice Address - Street 1:637 HOBOKEN RD
Practice Address - Street 2:
Practice Address - City:CARLSTADT
Practice Address - State:NJ
Practice Address - Zip Code:07072-1143
Practice Address - Country:US
Practice Address - Phone:201-842-0916
Practice Address - Fax:201-842-0706
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03344500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist