Healthcare Provider Details

I. General information

NPI: 1962757864
Provider Name (Legal Business Name): CENTURY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 W CENTURY RD SUITE 113
PARAMUS NJ
07652-1409
US

IV. Provider business mailing address

37 W CENTURY RD SUITE 113
PARAMUS NJ
07652-1409
US

V. Phone/Fax

Practice location:
  • Phone: 201-261-6479
  • Fax: 201-261-9479
Mailing address:
  • Phone: 201-261-6479
  • Fax: 201-261-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number28RS00720200
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. JUSTIN DIPISA
Title or Position: PHARMACIST
Credential:
Phone: 201-261-6479