Healthcare Provider Details

I. General information

NPI: 1760851414
Provider Name (Legal Business Name): EASY PHARMACY AT 601, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E MAIN ST
BRIDGEWATER NJ
08807-3257
US

IV. Provider business mailing address

601 E MAIN ST
BRIDGEWATER NJ
08807-3257
US

V. Phone/Fax

Practice location:
  • Phone: 908-927-9000
  • Fax: 908-927-9002
Mailing address:
  • Phone: 908-927-9000
  • Fax: 908-927-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number000
License Number StateNJ

VIII. Authorized Official

Name: MR. KIRAN PARVATRAO
Title or Position: PRES & CEO
Credential: RPH.
Phone: 732-667-7007