Healthcare Provider Details

I. General information

NPI: 1598828295
Provider Name (Legal Business Name): PARAMUS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 B E RIDGEWOOD AVE
PARAMUS NJ
07652
US

IV. Provider business mailing address

61 B E RIDGEWOOD AVE
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-599-3366
  • Fax: 201-599-3920
Mailing address:
  • Phone: 201-599-3366
  • Fax: 201-599-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00653600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2055330
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier0081949
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MANISH PUJARA
Title or Position: PRESIDENT
Credential:
Phone: 201-225-1661