Healthcare Provider Details

I. General information

NPI: 1073165403
Provider Name (Legal Business Name): QUICK MART PHARMACY & CONVENIENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RYDERS LN STE 5
MILLTOWN NJ
08850-1263
US

IV. Provider business mailing address

100 RYDERS LN STE 5
MILLTOWN NJ
08850-1263
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-7222
  • Fax: 732-545-4402
Mailing address:
  • Phone: 732-745-7222
  • Fax: 732-545-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALOK PATEL
Title or Position: MEMBER-LLC
Credential: PHARMACIST
Phone: 732-745-7222