Organization
SENELORM LLC
Active
Other names
Brick Church Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH SENELORM PHARMD (SUPERVISING PHARMACIST)
(646) 228-2311
Entity
Organization
Contact information
Practice address
520 MAIN ST, EAST ORANGE, NJ 07018-2217
(973) 395-2713
(973) 395-2715
Mailing address
520 MAIN ST, EAST ORANGE, NJ 07018-2217
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0668982
—
NJ
Enumeration date
08/21/2017
Last updated
04/07/2022
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