Organization
AQUAVITA LLC
Active
Other names
AquaVita
Organization subpart
No
Provider details
NPI number
Authorized official
FADY BISHAI (OWNER)
(732) 801-3235
Entity
Organization
Contact information
Practice address
630 TOWNE CENTRE DR, NORTH BRUNSWICK, NJ 08902-1236
(732) 658-3771
(888) 225-2388
Mailing address
630 TOWNE CENTRE DR, NORTH BRUNSWICK, NJ 08902-1236
(732) 658-3771
(888) 225-2388
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00737700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149917
PK
—
Enumeration date
02/02/2015
Last updated
02/02/2015
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