Healthcare Provider Details

I. General information

NPI: 1346258589
Provider Name (Legal Business Name): HERBERTS DRUG & SURGICAL SALES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 01/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 BERGEN AVE
JERSEY CITY NJ
07306-4705
US

IV. Provider business mailing address

753 BERGEN AVE
JERSEY CITY NJ
07306-4705
US

V. Phone/Fax

Practice location:
  • Phone: 201-333-7250
  • Fax: 201-200-0525
Mailing address:
  • Phone: 201-333-7250
  • Fax: 201-200-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01823600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number28RS00367400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00367400
License Number StateNJ

VIII. Authorized Official

Name: MR. JOHN C KIM
Title or Position: OWNER/PHARMACIST
Credential: R.PH
Phone: 201-333-7250