Healthcare Provider Details

I. General information

NPI: 1588226237
Provider Name (Legal Business Name): PREMIER HEALTH PHARMACY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 CENTRAL AVE
NEWARK NJ
07103-2842
US

IV. Provider business mailing address

393 CENTRAL AVE
NEWARK NJ
07103-2842
US

V. Phone/Fax

Practice location:
  • Phone: 973-219-7460
  • Fax:
Mailing address:
  • Phone: 973-991-3870
  • Fax: 973-991-3869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMIT PATEL
Title or Position: MEMBER
Credential:
Phone: 973-219-7460