Provider Demographics
NPI:1780227132
Name:GHARIB, HISHAM A
Entity type:Individual
Prefix:MR
First Name:HISHAM
Middle Name:A
Last Name:GHARIB
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 1:200 SPRINGFIELD AVE APT 5021
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1443
Mailing Address - Country:US
Mailing Address - Phone:973-883-6809
Mailing Address - Fax:
Practice Address - Street 1:215 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2708
Practice Address - Country:US
Practice Address - Phone:736-676-6779
Practice Address - Fax:973-667-6675
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03567400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist