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General NPI Number Information
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NPI Number | 1023316643
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Entity Type | Individual
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Provider Name | MOSTAFA WALI PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2011
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Last Update Date | 03/06/2011
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Provider Practice Location Address
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Address Line | 151 STATE ROUTE 94
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City | BLAIRSTOWN
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State | NJ
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Zip | 07825-2114
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Country | US
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Telephone | 908-362-6963
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Fax |
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Provider Business Mailing Address
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Address Line | 16 SAINT ANDREWS CT
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City | FLANDERS
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State | NJ
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Zip | 07836-4418
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI03025300
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License Number State | NJ
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