Healthcare Provider Details

I. General information

NPI: 1003468919
Provider Name (Legal Business Name): HARRYS DREAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 N OLDEN AVE
EWING NJ
08638-3102
US

IV. Provider business mailing address

108 MOUNTAINVIEW RD
MOUNT LAUREL NJ
08054-4729
US

V. Phone/Fax

Practice location:
  • Phone: 609-251-4500
  • Fax:
Mailing address:
  • Phone: 609-251-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HITENDRAKUMAR VITTHALBHAI PATEL
Title or Position: PRESIDENT
Credential:
Phone: 609-251-4500