Provider Demographics
NPI:1447853916
Name:GHABOOR, MERYAM
Entity type:Individual
Prefix:
First Name:MERYAM
Middle Name:
Last Name:GHABOOR
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 1:1600 PERRINEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-4923
Mailing Address - Country:US
Mailing Address - Phone:609-409-0136
Mailing Address - Fax:844-411-6860
Practice Address - Street 1:1600 PERRINEVILLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-4923
Practice Address - Country:US
Practice Address - Phone:609-409-0136
Practice Address - Fax:844-411-6860
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03290000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist