# BAYONNE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jerrys Drug & Surgical Supply
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639102940
- **Authorized official:** MR. MICHAEL L BOLOGH (OWNER)
- **Authorized official phone:** (201) 339-1992

## Contact information

- **Practice address:** 455 BROADWAY, BAYONNE, NJ 07002-3623
- **Practice address phone:** (201) 339-1992
- **Practice address fax:** (201) 858-1714
- **Mailing address:** 455 BROADWAY, BAYONNE, NJ 07002-3623
- **Mailing address phone:** (201) 339-1992
- **Mailing address fax:** (201) 858-1714

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | 28RS00532100 | NJ | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 28RS00532100 | NJ | — |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 28RS00532100 | NJ | Yes |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | — |

## Other

- **Enumeration date:** 07/09/2006
- **Last updated:** 03/11/2010