Organization
BAYONNE PHARMACY INC
Active
Other names
Jerrys Drug & Surgical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL L BOLOGH (OWNER)
(201) 339-1992
Entity
Organization
Contact information
Practice address
455 BROADWAY, BAYONNE, NJ 07002-3623
(201) 339-1992
(201) 858-1714
Mailing address
455 BROADWAY, BAYONNE, NJ 07002-3623
(201) 339-1992
(201) 858-1714
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
28RS00532100
NJ
332B00000X
Durable Medical Equipment & Medical Supplies
28RS00532100
NJ
332BC3200X
Customized Equipment (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00532100
NJ
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7195605
—
NJ
05
—
7195613
—
NJ
Enumeration date
07/09/2006
Last updated
03/11/2010
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