# FOURTH AVE PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** FOURTH AVENUE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225130354
- **Authorized official:** AYUSH GAJERA (PHARMACIST)
- **Authorized official phone:** (973) 483-3872

## Contact information

- **Practice address:** 329 ROSEVILLE AVE, NEWARK, NJ 07107-1757
- **Practice address phone:** (973) 483-3872
- **Practice address fax:** (973) 483-6956
- **Mailing address:** 329 ROSEVILLE AVE, NEWARK, NJ 07107-1757
- **Mailing address phone:** (973) 483-3872
- **Mailing address fax:** (973) 483-6956

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 28RS00335200 | NJ | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 09/01/2006
- **Last updated:** 04/19/2017