Healthcare Provider Details

I. General information

NPI: 1659596468
Provider Name (Legal Business Name): DAYTON PARK DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 GEORGES RD STE 5
DAYTON NJ
08810-1639
US

IV. Provider business mailing address

365 GEORGES RD STE 5
DAYTON NJ
08810-1639
US

V. Phone/Fax

Practice location:
  • Phone: 732-329-2626
  • Fax: 732-329-2215
Mailing address:
  • Phone: 732-329-2626
  • Fax: 732-329-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number28RS00652100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRS00652100
License Number StateNJ

VIII. Authorized Official

Name: MR. ASGHAR NATHOO
Title or Position: VICE PRESIDENT
Credential:
Phone: 732-329-2626