Healthcare Provider Details

I. General information

NPI: 1396126413
Provider Name (Legal Business Name): JIFFY SCRIPTS RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 PROMENADE BLVD
FAIR LAWN NJ
07410-2777
US

IV. Provider business mailing address

3110 PROMENADE BLVD
FAIR LAWN NJ
07410-2777
US

V. Phone/Fax

Practice location:
  • Phone: 201-590-2884
  • Fax: 551-225-1088
Mailing address:
  • Phone: 201-590-2884
  • Fax: 551-225-1088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARLENE VANGELAS
Title or Position: OWNER
Credential:
Phone: 201-819-2968