Healthcare Provider Details

I. General information

NPI: 1245759067
Provider Name (Legal Business Name): D AND D PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 E MAIN ST
OCEANPORT NJ
07757-1145
US

IV. Provider business mailing address

271 E MAIN ST
OCEANPORT NJ
07757-1145
US

V. Phone/Fax

Practice location:
  • Phone: 732-542-8607
  • Fax: 732-389-9022
Mailing address:
  • Phone: 732-542-8607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00613900
License Number StateNJ

VIII. Authorized Official

Name: MERVAT GIRGIS
Title or Position: OWNER
Credential:
Phone: 732-542-8607