Healthcare Provider Details

I. General information

NPI: 1114832532
Provider Name (Legal Business Name): MELISSA JULIA KUDLAK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24-12 FAIR LAWN AVE
FAIR LAWN NJ
07410-3401
US

IV. Provider business mailing address

1045 LAKE DR
FRANKLIN LAKES NJ
07417-1602
US

V. Phone/Fax

Practice location:
  • Phone: 201-797-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04512800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: