Healthcare Provider Details

I. General information

NPI: 1790809119
Provider Name (Legal Business Name): NATURE MED PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/07/2023
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 ANDERSON AVENUE
CLIFFSIDE PARK NJ
07010
US

IV. Provider business mailing address

518 ANDERSON AVENUE
CLIFFSIDE PARK NJ
07010
US

V. Phone/Fax

Practice location:
  • Phone: 201-945-8006
  • Fax: 201-945-7650
Mailing address:
  • Phone: 201-945-8006
  • Fax: 201-945-7650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00637600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. OLEG BEDA
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 201-945-8006