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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