Provider Demographics
NPI:1649963521
Name:MINIHAN, DEIRDRE (PHARMD, BCPS, BCIDP)
Entity type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:
Last Name:MINIHAN
Suffix:
Gender:F
Credentials:PHARMD, BCPS, BCIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1421
Mailing Address - Country:US
Mailing Address - Phone:201-615-7566
Mailing Address - Fax:
Practice Address - Street 1:6 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1421
Practice Address - Country:US
Practice Address - Phone:201-615-7566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050941183500000X
AZS017936183500000X
NJ28RI02880800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist