Provider Demographics
NPI:1245727882
Name:MOAWAD, MIRNA M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MIRNA
Middle Name:M
Last Name:MOAWAD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 WIERIMUS RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-1133
Mailing Address - Country:US
Mailing Address - Phone:201-674-6775
Mailing Address - Fax:
Practice Address - Street 1:270 WIERIMUS RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-1133
Practice Address - Country:US
Practice Address - Phone:201-674-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03439300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist