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General NPI Number Information
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NPI Number | 1508512195
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Entity Type | Individual
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Provider Name | MALVI DEVANATHAN
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Gender | Female
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 2405 HAMBURG TPKE
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City | WAYNE
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State | NJ
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Zip | 07470-6287
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Country | US
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Telephone | 973-831-4080
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Fax |
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Provider Business Mailing Address
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Address Line | 210 MAIN STREET #508
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City | HACKENSACK
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State | NJ
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Zip | 07601
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Country | US
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Telephone | 216-338-1169
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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 | 28RI04198300
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License Number State | NJ
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