Organization
JEA AVA MARIA LLC
Active
Other names
MAIN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GHALY (MANAGING MEMBER)
(973) 334-0519
Entity
Organization
Contact information
Practice address
203 MAIN ST, BOONTON, NJ 07005-1749
(973) 334-0519
(973) 334-9390
Mailing address
203 MAIN ST, BOONTON, NJ 07005-1749
(973) 334-0519
(973) 334-9390
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
09/02/2021
Last updated
09/02/2021
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