Active NPI
Mary Phan
- Pharmacist
- Kearny, NJ
National Provider Identifier
1205618543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RI04339000
- Practice address
- 465 Kearny Ave
Kearny, NJ 07032-2702 - Phone
- (201) 428-2376
- NPI assigned
- Oct 20, 2023
- Last updated
- Oct 20, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RI04339000 | NJ | Primary |
Addresses
Primary practice location
465 Kearny Ave
Kearny, NJ 07032-2702
Mailing address
129 Smallwood Ave
Belleville, NJ 07109-1330
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI04339000 | NJ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
465 Kearny Ave
Kearny, NJ 07032
Phone (201) 428-2376
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1697760000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697760000000",
"number": "1205618543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "129 SMALLWOOD AVE",
"city": "BELLEVILLE",
"state": "NJ",
"postal_code": "071091330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "465 KEARNY AVE",
"city": "KEARNY",
"state": "NJ",
"postal_code": "070322702",
"telephone_number": "201-428-2376"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-10-20",
"last_updated": "2023-10-20",
"certification_date": "2023-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI04339000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kearny, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.