Healthcare Provider Details

I. General information

NPI: 1417873001
Provider Name (Legal Business Name): GEORGE AZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 RONNIE RD
WAYNE NJ
07470-3910
US

IV. Provider business mailing address

10 RONNIE RD
WAYNE NJ
07470-3910
US

V. Phone/Fax

Practice location:
  • Phone: 973-682-2100
  • Fax:
Mailing address:
  • Phone: 973-682-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03768800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: