Healthcare Provider Details

I. General information

NPI: 1588429054
Provider Name (Legal Business Name): APOLLO PHARMACY RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SUMMER AVE
NEWARK NJ
07104-1903
US

IV. Provider business mailing address

130 SUMMER AVE
NEWARK NJ
07104-1903
US

V. Phone/Fax

Practice location:
  • Phone: 973-350-6155
  • Fax: 973-556-1560
Mailing address:
  • Phone: 973-350-6155
  • Fax: 973-556-1560

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
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. FARIBORZ ARYAFAR
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 201-207-1325