Organization
ELIZABETH PHARMACY INC
Active
Other names
Goethals Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PRABODH AJBANI (SHAREHOLDER)
(908) 527-1112
Entity
Organization
Contact information
Practice address
638 BAYWAY AVE, ELIZABETH, NJ 07202-2613
(908) 527-1112
(908) 527-1155
Mailing address
638 BAYWAY AVE, ELIZABETH, NJ 07202-2613
(908) 527-1112
(908) 527-1155
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00718500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0346527
—
NJ
01
—
2137381
PK
—
Enumeration date
06/15/2012
Last updated
09/30/2016
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