Healthcare Provider Details

I. General information

NPI: 1245512904
Provider Name (Legal Business Name): MARIANA GOLYAK PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2011
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 HOBOKEN RD
CARLSTADT NJ
07072-1143
US

IV. Provider business mailing address

668 PROSPECT ST
GLEN ROCK NJ
07452-2420
US

V. Phone/Fax

Practice location:
  • Phone: 201-842-0916
  • Fax: 201-842-0706
Mailing address:
  • Phone: 201-321-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03344500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: