Healthcare Provider Details

I. General information

NPI: 1689986424
Provider Name (Legal Business Name): PHARMACY PLUS & SURGICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 HARRISON AVE
HARRISON NJ
07029-1347
US

IV. Provider business mailing address

236 HARRISON AVE
HARRISON NJ
07029-1347
US

V. Phone/Fax

Practice location:
  • Phone: 973-900-9275
  • Fax: 862-849-2189
Mailing address:
  • Phone: 973-900-9275
  • Fax: 862-849-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00705100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KHALID BADER
Title or Position: PHARMACIST-IN-CHARGE
Credential:
Phone: 201-757-9664