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NPI Code Detail

MEDICARE: JEN PHARMA INC

MEDICARE: JEN PHARMA INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy28RS00706100NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12126667OTHERPK

General Provider Information

NPI Number : 1154362036
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEN PHARMA INC
Provider Business Mailing Address
First Line : 205 SUMMER AVE
Second Line :
City : NEWARK
State : NJ
Zip : 07104-2628
Country : US
Telephone Number : 973-481-3388
Fax Number : 973-481-0625
Provider Business Practice Location Address
First Line : 205 SUMMER AVE
Second Line :
City : NEWARK
State : NJ
Zip : 07104-2628
Country : US
Telephone Number : 973-481-3388
Fax Number : 973-481-0625
Authorized Official
Title or Position : PRESIDENT
Name : SMITHA DASARI
Credential :
Telephone Number : 973-481-3388
Provider Enumeration Date : 06/09/2006
Last Update Date : 02/09/2023

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