Healthcare Provider Details

I. General information

NPI: 1881787729
Provider Name (Legal Business Name): ST. JOSEPH'S PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7917 KENNEDY BLVD
NORTH BERGEN NJ
07047-4137
US

IV. Provider business mailing address

7917 KENNEDY BLVD
NORTH BERGEN NJ
07047-4137
US

V. Phone/Fax

Practice location:
  • Phone: 201-869-4949
  • Fax: 201-869-4993
Mailing address:
  • Phone: 201-869-4949
  • Fax: 201-869-4993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRS00648200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberRS00648200
License Number StateNJ

VIII. Authorized Official

Name: DR. FREDDY HERNANDEZ
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D., R.PH.
Phone: 201-869-4949