Healthcare Provider Details

I. General information

NPI: 1861769291
Provider Name (Legal Business Name): MARIA OLMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MARKET ST
PATERSON NJ
07501-1721
US

IV. Provider business mailing address

263 JACKSONVILLE DR
PARSIPPANY NJ
07054-5018
US

V. Phone/Fax

Practice location:
  • Phone: 973-523-2070
  • Fax: 973-523-2590
Mailing address:
  • Phone: 973-463-9101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03193700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: