Healthcare Provider Details

I. General information

NPI: 1639003346
Provider Name (Legal Business Name): FAIRFIELD PHARMACY RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 HOLLYWOOD AVE STE 4
FAIRFIELD NJ
07004-2406
US

IV. Provider business mailing address

43 LINDEN AVE
LINCOLN PARK NJ
07035-2545
US

V. Phone/Fax

Practice location:
  • Phone: 862-213-2061
  • Fax:
Mailing address:
  • Phone: 862-213-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHATHA KHALIL
Title or Position: OWNER
Credential:
Phone: 862-213-2061