Healthcare Provider Details

I. General information

NPI: 1407966757
Provider Name (Legal Business Name): MERVAT GIRGIS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 E MAIN ST
OCEANPORT NJ
07757
US

IV. Provider business mailing address

73 CASCADES AVE
HOWELL NJ
07731
US

V. Phone/Fax

Practice location:
  • Phone: 732-542-8607
  • Fax: 832-389-9022
Mailing address:
  • Phone: 732-919-2372
  • Fax: 732-389-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02066600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: