Healthcare Provider Details

I. General information

NPI: 1114242484
Provider Name (Legal Business Name): YNAAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1578 MAIN AVE
CLIFTON NJ
07011-2160
US

IV. Provider business mailing address

1578 MAIN AVE
CLIFTON NJ
07011-2160
US

V. Phone/Fax

Practice location:
  • Phone: 973-955-4000
  • Fax: 973-955-4004
Mailing address:
  • Phone: 973-955-4000
  • Fax: 973-955-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00702200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number28RS00702200
License Number StateNJ

VIII. Authorized Official

Name: N A
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 973-955-4000