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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00335200
NJ
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2132840
PK
—
Enumeration date
09/01/2006
Last updated
04/19/2017
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