Healthcare Provider Details

I. General information

NPI: 1174816441
Provider Name (Legal Business Name): JAMES HENNIG R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 METRO BLVD
CLIFTON NJ
07014
US

IV. Provider business mailing address

12 MEADOW LN
VERONA NJ
07044-1811
US

V. Phone/Fax

Practice location:
  • Phone: 973-230-6620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01693200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: