Basic Information
| Provider Information | |||||||||
| NPI: | 1578149985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAHIM | ||||||||
| FirstName: | GERMIN | ||||||||
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| Credential: | PHARMD, BCPS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 JENNIFER DR | ||||||||
| Address2: | |||||||||
| City: | HOLMDEL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077331619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673373069 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BRANCH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077406303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329235000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2021 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 28RI03593500 | NJ | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.