# JEA AVA MARIA LLC

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

## Provider details

- **NPI number:** 1457029563
- **Authorized official:** JOHN GHALY (MANAGING MEMBER)
- **Authorized official phone:** (973) 334-0519

## Contact information

- **Practice address:** 203 MAIN ST, BOONTON, NJ 07005-1749
- **Practice address phone:** (973) 334-0519
- **Practice address fax:** (973) 334-9390
- **Mailing address:** 203 MAIN ST, BOONTON, NJ 07005-1749
- **Mailing address phone:** (973) 334-0519
- **Mailing address fax:** (973) 334-9390

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 09/02/2021
- **Last updated:** 09/02/2021