Healthcare Provider Details

I. General information

NPI: 1457456311
Provider Name (Legal Business Name): MEDICAL ARTS PHARMACY INC III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07305-2106
US

IV. Provider business mailing address

1825 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07305-2106
US

V. Phone/Fax

Practice location:
  • Phone: 201-369-6918
  • Fax: 201-333-1149
Mailing address:
  • Phone: 201-369-6918
  • Fax: 201-333-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00656700
License Number StateNJ

VIII. Authorized Official

Name: JEFF HERTZ
Title or Position: OWNER
Credential:
Phone: 201-369-6918