Healthcare Provider Details

I. General information

NPI: 1982237103
Provider Name (Legal Business Name): HOLMDEL PHARMACY & DELI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 STATE ROUTE 35 UNIT 2A2
HOLMDEL NJ
07733-1164
US

IV. Provider business mailing address

2145 STATE ROUTE 35 UNIT 2A2
HOLMDEL NJ
07733-1164
US

V. Phone/Fax

Practice location:
  • Phone: 732-787-6666
  • Fax: 732-787-2222
Mailing address:
  • Phone: 732-787-6666
  • Fax: 732-787-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MARIAN MIKAILE
Title or Position: PRESIDENT
Credential:
Phone: 201-423-3300