Provider Demographics
NPI:1679176044
Name:SIA, MARIE DOMINIQUE IMPORTANTE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:MARIE DOMINIQUE
Middle Name:IMPORTANTE
Last Name:SIA
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-9748
Mailing Address - Country:US
Mailing Address - Phone:973-927-4662
Mailing Address - Fax:973-927-4668
Practice Address - Street 1:1105 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852-9748
Practice Address - Country:US
Practice Address - Phone:973-927-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237986183500000X
NJ28RI04018400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist