Provider Demographics
NPI:1578370151
Name:DIAZ, XAVIER MIGUEL (PHARMD)
Entity type:Individual
Prefix:
First Name:XAVIER
Middle Name:MIGUEL
Last Name:DIAZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MALCOLM AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1123
Mailing Address - Country:US
Mailing Address - Phone:201-790-8881
Mailing Address - Fax:
Practice Address - Street 1:8 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5731
Practice Address - Country:US
Practice Address - Phone:973-743-6413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04408100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist