Provider Demographics
NPI:1679206049
Name:TAMMAA, ELMOATAZBELLAH A
Entity type:Individual
Prefix:MR
First Name:ELMOATAZBELLAH
Middle Name:A
Last Name:TAMMAA
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 1:355-363 CENTRAL AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018
Mailing Address - Country:US
Mailing Address - Phone:973-666-5363
Mailing Address - Fax:973-577-2686
Practice Address - Street 1:355-363 CENTRAL AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:973-666-5363
Practice Address - Fax:973-577-2686
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04028400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist