Organization
PASSAIC PHARMACY INC
Active
Other names
TONYS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTONIO ORESTES RODRIGUEZ (PRESIDENT)
(973) 777-3121
Entity
Organization
Contact information
Practice address
291 MONROE ST, PASSAIC, NJ 07055-5209
(973) 777-3121
(973) 777-3181
Mailing address
291 MONROE ST, PASSAIC, NJ 07055-5209
(973) 777-3121
(973) 777-3181
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
28RS00414400
NJ
333600000X
Pharmacy
28RS00414400
NJ
3336C0003X
Community/Retail Pharmacy
Primary
28RS00414400
NJ
3336C0004X
Compounding Pharmacy
28RS00414400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1657801
—
NJ
05
—
4396707
—
NJ
Enumeration date
12/14/2005
Last updated
02/01/2010
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