Healthcare Provider Details

I. General information

NPI: 1932818556
Provider Name (Legal Business Name): PENIEL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 MAIN ST
HACKENSACK NJ
07601-7300
US

IV. Provider business mailing address

191 MAIN ST
HACKENSACK NJ
07601-7300
US

V. Phone/Fax

Practice location:
  • Phone: 973-807-2763
  • Fax:
Mailing address:
  • Phone: 201-416-4377
  • Fax: 201-416-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. DELOVE JEREMY ARTHUR
Title or Position: PHARMACIST
Credential: RPH
Phone: 973-807-2763