Provider Demographics
NPI:1366171837
Name:FARAGALLA, FOUAD
Entity type:Individual
Prefix:MR
First Name:FOUAD
Middle Name:
Last Name:FARAGALLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 NORMAN WAY
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5312
Mailing Address - Country:US
Mailing Address - Phone:120-193-2646
Mailing Address - Fax:
Practice Address - Street 1:764 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2640
Practice Address - Country:US
Practice Address - Phone:973-278-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03849000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist