Healthcare Provider Details

I. General information

NPI: 1316446594
Provider Name (Legal Business Name): CLIFTON PHARMACY RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 CLIFTON AVE
CLIFTON NJ
07011-1842
US

IV. Provider business mailing address

261 CLIFTON AVE
CLIFTON NJ
07011-1842
US

V. Phone/Fax

Practice location:
  • Phone: 862-225-9726
  • Fax: 862-225-9728
Mailing address:
  • Phone: 862-225-9726
  • Fax: 862-225-9728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00761200
License Number StateNJ

VIII. Authorized Official

Name: USMAN TANVIR
Title or Position: OWNER/PRESIDENT/AO
Credential:
Phone: 862-225-9726