Provider Demographics
NPI:1144545567
Name:MIKHAIL, WAFAA G (RPH)
Entity type:Individual
Prefix:MISS
First Name:WAFAA
Middle Name:G
Last Name:MIKHAIL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CENTRAL AVE
Mailing Address - Street 2:APT #1601
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5302
Mailing Address - Country:US
Mailing Address - Phone:201-766-1723
Mailing Address - Fax:
Practice Address - Street 1:500 CENTRAL AVE
Practice Address - Street 2:APT #1601
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5302
Practice Address - Country:US
Practice Address - Phone:201-766-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R101758600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist