Provider Demographics
NPI:1659185791
Name:MACIAG AND TAWADROS
Entity type:Organization
Organization Name:MACIAG AND TAWADROS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWADOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD; RPH, MBA
Authorized Official - Phone:973-473-2243
Mailing Address - Street 1:105 TERHUNE AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-2805
Mailing Address - Country:US
Mailing Address - Phone:973-473-2243
Mailing Address - Fax:973-473-8387
Practice Address - Street 1:105 TERHUNE AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-2805
Practice Address - Country:US
Practice Address - Phone:973-473-2243
Practice Address - Fax:973-473-8387
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MACIAG & TAWADROS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy