Healthcare Provider Details

I. General information

NPI: 1528293602
Provider Name (Legal Business Name): NANCY NASHAAT NAGIB MOUSSA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 JACKSON DR
CRANFORD NJ
07016-3510
US

IV. Provider business mailing address

104 COUNTRY VILLAGE RD
JERSEY CITY NJ
07305-1241
US

V. Phone/Fax

Practice location:
  • Phone: 908-931-9111
  • Fax:
Mailing address:
  • Phone: 201-203-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03181200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: