Provider Demographics
NPI:1861707713
Name:YACOUB, CAROLINE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:
Last Name:YACOUB
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 1:2859 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3901
Mailing Address - Country:US
Mailing Address - Phone:201-433-2826
Mailing Address - Fax:201-433-6257
Practice Address - Street 1:2859 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3901
Practice Address - Country:US
Practice Address - Phone:201-433-2826
Practice Address - Fax:201-433-6257
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03265600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist