Healthcare Provider Details

I. General information

NPI: 1730093022
Provider Name (Legal Business Name): MARIA MANSOUR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 HOOPER AVE
BRICK NJ
08723-6239
US

IV. Provider business mailing address

4 NICOLE CT
JACKSON NJ
08527-2400
US

V. Phone/Fax

Practice location:
  • Phone: 732-477-3428
  • Fax:
Mailing address:
  • Phone: 732-755-7430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04524600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: