Healthcare Provider Details

I. General information

NPI: 1770685794
Provider Name (Legal Business Name): SLC PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/03/2023
Certification Date: 06/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 NEWARK AVENUE
JERSEY CITY NJ
07306
US

IV. Provider business mailing address

570 NEWARK AVENUE
JERSEY CITY NJ
07306
US

V. Phone/Fax

Practice location:
  • Phone: 201-653-4093
  • Fax: 201-222-1901
Mailing address:
  • Phone: 201-653-4093
  • Fax: 201-222-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00672800
License Number StateNJ

VIII. Authorized Official

Name: MR. MARIO GERGES
Title or Position: PHARMACIST IN CHARGE OWNER
Credential: RPH
Phone: 201-653-4093