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Organization
21ST AVE PHARMACY INC.
Active
Organization
21ST AVE PHARMACY INC.
Active
Other names
TONYS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTONIO ORESTES RODRIGUEZ (PRESIDENT)
(973) 742-1235
Entity
Organization
Contact information
Practice address
357 21ST AVE, PATERSON, NJ 07501-3642
(973) 742-1235
(973) 742-0353
Mailing address
357 21ST AVE, PATERSON, NJ 07501-3642
(973) 742-1235
(973) 742-0353
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
28RS00334800
NJ
332B00000X
Durable Medical Equipment & Medical Supplies
28RS003348
NJ
3336C0003X
Community/Retail Pharmacy
Primary
28RS003348
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0107905
—
NJ
05
—
4344600
—
NJ
Enumeration date
12/09/2005
Last updated
02/19/2009
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