Healthcare Provider Details

I. General information

NPI: 1982226999
Provider Name (Legal Business Name): NANCY FAKHRY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 SAINT GEORGES AVE
RAHWAY NJ
07065-2695
US

IV. Provider business mailing address

3230 VICTORY BLVD APT 5F
STATEN ISLAND NY
10314-6754
US

V. Phone/Fax

Practice location:
  • Phone: 732-396-1990
  • Fax:
Mailing address:
  • Phone: 646-250-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number066611
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04042900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: