Healthcare Provider Details

I. General information

NPI: 1427469675
Provider Name (Legal Business Name): PALISADE AVE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07305-2180
US

IV. Provider business mailing address

1815 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07305-2180
US

V. Phone/Fax

Practice location:
  • Phone: 201-433-8900
  • Fax: 800-856-4176
Mailing address:
  • Phone: 201-433-8900
  • Fax: 800-856-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GERARDO LEBRON
Title or Position: OWNER
Credential:
Phone: 201-433-8900