Healthcare Provider Details

I. General information

NPI: 1740291392
Provider Name (Legal Business Name): SIMPLE SIMON PHARMACY DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 A EAST RIDGEWOOD AVE
PARAMUS NJ
07652
US

IV. Provider business mailing address

67 A EAST RIDGEWOOD AVE
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-225-1040
  • Fax: 201-225-1055
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRS00635700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NIKHIL PATEL
Title or Position: PRESIDENT
Credential:
Phone: 201-225-1040