Provider Demographics
NPI:1174079859
Name:SALAMA, MERNA MAGED MOURIS
Entity type:Individual
Prefix:
First Name:MERNA
Middle Name:MAGED MOURIS
Last Name:SALAMA
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 1:30 EBBITTS ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4829
Mailing Address - Country:US
Mailing Address - Phone:347-272-3452
Mailing Address - Fax:
Practice Address - Street 1:30 EBBITTS ST APT 4B
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4829
Practice Address - Country:US
Practice Address - Phone:347-272-3452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03802400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist