Healthcare Provider Details

I. General information

NPI: 1184966863
Provider Name (Legal Business Name): USAMA RUSHDY WAHBA ESKAROS PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 SMITH ST
PERTH AMBOY NJ
08861-4042
US

IV. Provider business mailing address

288 SMITH ST
PERTH AMBOY NJ
08861-4042
US

V. Phone/Fax

Practice location:
  • Phone: 732-324-4490
  • Fax:
Mailing address:
  • Phone: 732-324-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03489200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52405
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: