Organization
MAIN AVENUE PHARMACY CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCI LIENECK (OPERATIONS MANAGER)
(973) 928-0208
Entity
Organization
Contact information
Practice address
1094 MAIN AVE STE A, CLIFTON, NJ 07011-2384
(973) 928-0208
Mailing address
1094 MAIN AVE STE A, CLIFTON, NJ 07011-2384
(973) 928-0208
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276006
—
NJ
Enumeration date
05/11/2011
Last updated
09/02/2015
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