Healthcare Provider Details

I. General information

NPI: 1033997291
Provider Name (Legal Business Name): MOHINI VAKIL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 ROSEVILLE AVE
NEWARK NJ
07107-1757
US

IV. Provider business mailing address

329 ROSEVILLE AVE
NEWARK NJ
07107-1757
US

V. Phone/Fax

Practice location:
  • Phone: 201-952-3393
  • Fax:
Mailing address:
  • Phone: 973-483-3872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04255700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP456388
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: