Organization
FRESH EMPORIUM FOOD MARKET, CORP
Active
Other names
Fresh Imperium Pharmacy Jefferson
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL GRANGER (DIRECTOR OF PHARMACY)
(717) 324-4924
Entity
Organization
Contact information
Practice address
757 STATE ROUTE 15 S, LAKE HOPATCONG, NJ 07849-2284
(862) 803-9027
Mailing address
757 STATE ROUTE 15 S, LAKE HOPATCONG, NJ 07849-2284
(862) 803-9027
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
28RS00753600
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2167102
PK
—
Enumeration date
01/17/2017
Last updated
01/17/2017
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