Provider Demographics
NPI:1982074902
Name:TAWFIK, MARYANA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARYANA
Middle Name:
Last Name:TAWFIK
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 BRAISTED AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6134
Mailing Address - Country:US
Mailing Address - Phone:718-477-0268
Mailing Address - Fax:718-477-0268
Practice Address - Street 1:84 CLARK ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2721
Practice Address - Country:US
Practice Address - Phone:347-987-4315
Practice Address - Fax:347-987-4316
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060334-I183500000X
NJ28RI03534600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist