Individual
MARY PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
465 KEARNY AVE, KEARNY, NJ 07032-2702
(201) 428-2376
Mailing address
129 SMALLWOOD AVE, BELLEVILLE, NJ 07109-1330
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28RI04339000
NJ
Other
Enumeration date
10/20/2023
Last updated
10/20/2023
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