Healthcare Provider Details

I. General information

NPI: 1902710551
Provider Name (Legal Business Name): CLARK COMMUNITY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 RARITAN RD
CLARK NJ
07066-1316
US

IV. Provider business mailing address

1057 RARITAN RD
CLARK NJ
07066-1316
US

V. Phone/Fax

Practice location:
  • Phone: 201-255-4555
  • Fax: 201-502-2322
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: HANY WALY
Title or Position: MEMBER
Credential:
Phone: 201-255-4555