Healthcare Provider Details

I. General information

NPI: 1336665827
Provider Name (Legal Business Name): 110 VAN HOUTEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 VAN HOUTEN AVE
PASSAIC NJ
07055
US

IV. Provider business mailing address

110 VAN HOUTEN AVE
PASSAIC NJ
07055-4602
US

V. Phone/Fax

Practice location:
  • Phone: 973-955-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ASHWIN PATEL
Title or Position: PHARMACIST
Credential:
Phone: 551-221-5929