Healthcare Provider Details

I. General information

NPI: 1821089186
Provider Name (Legal Business Name): RODEO PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BROAD AVE STE 202
PALISADES PARK NJ
07650
US

IV. Provider business mailing address

225 BROAD AVE STE 202
PALISADES PARK NJ
07650-1590
US

V. Phone/Fax

Practice location:
  • Phone: 201-363-1181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00545100
License Number StateNJ

VIII. Authorized Official

Name: MRS. BYUNGDUCK LEE
Title or Position: PHARMACIST
Credential:
Phone: 201-363-1181