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Organization
FOURTH AVE PHARMACY LLC
Active
Organization
FOURTH AVE PHARMACY LLC
Active
Other names
FOURTH AVENUE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AYUSH GAJERA (PHARMACIST)
(973) 483-3872
Entity
Organization
Contact information
Practice address
329 ROSEVILLE AVE, NEWARK, NJ 07107-1757
(973) 483-3872
(973) 483-6956
Mailing address
329 ROSEVILLE AVE, NEWARK, NJ 07107-1757
(973) 483-3872
(973) 483-6956
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
28RS00335200
NJ
3336S0011X
Specialty Pharmacy
—
NULL
Other
Enumeration date
09/01/2006
Last updated
04/19/2017
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