Healthcare Provider Details

I. General information

NPI: 1457493041
Provider Name (Legal Business Name): KRESSATYS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 RINGWOOD AVE
HASKELL NJ
07420-1441
US

IV. Provider business mailing address

1068 RINGWOOD AVE
HASKELL NJ
07420-1441
US

V. Phone/Fax

Practice location:
  • Phone: 973-835-1627
  • Fax: 973-835-9111
Mailing address:
  • Phone: 973-835-1627
  • Fax: 973-835-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00043400
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier4272901
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MUHAMMAD ADEEL
Title or Position: OWNER
Credential:
Phone: 973-835-1627