MEDICARE: FORT LEE PHARMACY & SURGICAL 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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	RS00613000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2055063	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922110923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT LEE PHARMACY & SURGICAL INC

Provider Business Mailing Address
First Line	:	1562 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5652
Country	:	US
Telephone Number	:	201-346-9202
Fax Number	:	201-346-9212

Provider Business Practice Location Address
First Line	:	1562 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5652
Country	:	US
Telephone Number	:	201-346-9202
Fax Number	:	201-346-9212

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MYEONGHA JO
Credential	:
Telephone Number	:	201-346-9202

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/04/2024

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