Provider Demographics
NPI:1295316297
Name:SIYAM PHARMACY LLC
Entity type:Organization
Organization Name:SIYAM PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MOHANNAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIYAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:856-473-3955
Mailing Address - Street 1:601 4TH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2818
Mailing Address - Country:US
Mailing Address - Phone:856-473-3955
Mailing Address - Fax:856-473-3976
Practice Address - Street 1:601 4TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2818
Practice Address - Country:US
Practice Address - Phone:856-473-3955
Practice Address - Fax:856-473-3976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy