Organization
BROAD PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MUN-HYUK KWON R.PH. (PRESIDENT)
(201) 313-0111
Entity
Organization
Contact information
Practice address
17 BROAD AVE, PALISADES PARK, NJ 07650-1403
(201) 313-0111
(201) 313-0577
Mailing address
17 BROAD AVE, PALISADES PARK, NJ 07650-1403
(201) 313-0111
(201) 313-0577
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
28RS00536800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7122802
—
NJ
Enumeration date
10/11/2006
Last updated
01/07/2009
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