Provider Demographics
NPI:1861769291
Name:OLMOS, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:OLMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 JACKSONVILLE DR
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-5018
Mailing Address - Country:US
Mailing Address - Phone:973-463-9101
Mailing Address - Fax:
Practice Address - Street 1:22 MARKET ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-1721
Practice Address - Country:US
Practice Address - Phone:973-523-2070
Practice Address - Fax:973-523-2590
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03193700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9123601Medicaid