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General NPI Number Information
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NPI Number | 1336369131
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Entity Type | Individual
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Provider Name | PETER ISHAK PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2022 E SAINT GEORGES AVE
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City | LINDEN
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State | NJ
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Zip | 07036-1048
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Country | US
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Telephone | 908-925-0704
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Fax |
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Provider Business Mailing Address
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Address Line | 43 PEBBLE CREEK RD
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City | DAYTON
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State | NJ
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Zip | 08810-1618
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Country | US
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Telephone | 732-718-8108
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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 | 28RI02992200
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License Number State | NJ
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