Healthcare Provider Details

I. General information

NPI: 1639488422
Provider Name (Legal Business Name): DRUG STORES ONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 08/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22-18 BROADWAY SUITE # 5
FAIR LAWN NJ
07410-3016
US

IV. Provider business mailing address

22-18 BROADWAY SUITE #5
FAIR LAWN NJ
07410-3016
US

V. Phone/Fax

Practice location:
  • Phone: 201-773-6666
  • Fax: 201-773-6667
Mailing address:
  • Phone: 201-773-6666
  • Fax: 201-773-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP05530
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number28RS00707700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PIUSHBHAI PATEL
Title or Position: PRESIDENT
Credential:
Phone: 201-773-6666