Healthcare Provider Details

I. General information

NPI: 1851432983
Provider Name (Legal Business Name): AVON RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 JACKSON ST
HOBOKEN NJ
07030-6879
US

IV. Provider business mailing address

222 JACKSON ST
HOBOKEN NJ
07030-6879
US

V. Phone/Fax

Practice location:
  • Phone: 201-420-8300
  • Fax: 201-420-8333
Mailing address:
  • Phone: 201-420-8300
  • Fax: 201-420-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00576700
License Number StateNJ

VIII. Authorized Official

Name: ASHRAF ASHAMALLA
Title or Position: PRESIDENT
Credential: R.PH
Phone: 201-820-8300