Healthcare Provider Details

I. General information

NPI: 1801902556
Provider Name (Legal Business Name): MARY V ALEXANDER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY D VARGHESE RPH

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD
LYONS NJ
07939-5001
US

IV. Provider business mailing address

708 RIVERSIDE AVE
RARITAN NJ
08869-1123
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax: 908-604-5267
Mailing address:
  • Phone: 908-253-6118
  • Fax: 908-253-6118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: