Healthcare Provider Details

I. General information

NPI: 1205313996
Provider Name (Legal Business Name): SAWP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 12/29/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 BROADWAY
ELMWOOD PARK NJ
07407-3522
US

IV. Provider business mailing address

260 BROADWAY
ELMWOOD PARK NJ
07407-3522
US

V. Phone/Fax

Practice location:
  • Phone: 973-324-1000
  • Fax: 973-324-2121
Mailing address:
  • Phone: 973-324-1000
  • Fax: 973-324-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00765900
License Number StateNJ

VIII. Authorized Official

Name: SYED M HUSSAINI
Title or Position: MANAGING MEMBER
Credential: MBA
Phone: 201-552-9500