Provider Demographics
NPI:1356066005
Name:RADWAN, AMR ALY
Entity type:Individual
Prefix:
First Name:AMR
Middle Name:ALY
Last Name:RADWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROOSEVELT BLVD
Mailing Address - Street 2:CVS MARMORA
Mailing Address - City:NJ
Mailing Address - State:NJ
Mailing Address - Zip Code:08223
Mailing Address - Country:US
Mailing Address - Phone:609-390-0060
Mailing Address - Fax:609-390-0016
Practice Address - Street 1:1 ROOSEVELT BLVD
Practice Address - Street 2:CVS MARMORA
Practice Address - City:NJ
Practice Address - State:NJ
Practice Address - Zip Code:08223-0822
Practice Address - Country:US
Practice Address - Phone:609-390-0060
Practice Address - Fax:609-390-0016
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03934400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist