MEDICARE: MISHA HEALTHCARE LLC

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	3336C0003X	Community/Retail Pharmacy	28RS00672700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2055778	OTHER		PK

General Provider Information

NPI Number	:	1982619516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISHA HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	568 W SIDE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-1741
Country	:	US
Telephone Number	:	201-433-9777
Fax Number	:	201-433-9779

Provider Business Practice Location Address
First Line	:	568 W SIDE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-1741
Country	:	US
Telephone Number	:	201-433-9777
Fax Number	:	201-433-9779

Authorized Official
Title or Position	:	PHARMACIST
Name	:	JANAK PATEL
Credential	:
Telephone Number	:	201-433-9777

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	01/17/2017

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Directions to “MISHA HEALTHCARE LLC ” Practice Location

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