Basic Information
| Provider Information | |||||||||
| NPI: | 1366637282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ISMAIL | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 624 MARC DRIVE | ||||||||
| Address2: | |||||||||
| City: | NORTH BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734203047 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 136 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | CLARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070661142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325749015 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2007 | ||||||||
| LastUpdateDate: | 09/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 28RI02614200 | NJ | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.