Organization
PASSAIC COMMUNITY PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM AWAD PHARM-D (OFFICER)
(973) 471-0160
Entity
Organization
Contact information
Practice address
339 PASSAIC ST, PASSAIC, NJ 07055-5818
(973) 471-0160
(973) 471-0110
Mailing address
339 PASSAIC ST, PASSAIC, NJ 07055-5818
(973) 471-0160
(973) 471-0110
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
28RS00592100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8428310
—
NJ
Enumeration date
09/15/2017
Last updated
06/16/2018
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