Healthcare Provider Details

I. General information

NPI: 1023975414
Provider Name (Legal Business Name): MARIAM AMMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 VALLEY RD
UPPER MONTCLAIR NJ
07043-1825
US

IV. Provider business mailing address

10 JOHN HENRY DR
MONTVILLE NJ
07045-9534
US

V. Phone/Fax

Practice location:
  • Phone: 201-673-0251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04478000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: