Healthcare Provider Details

I. General information

NPI: 1497052245
Provider Name (Legal Business Name): PARK AVE DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 PARK AVE
PATERSON NJ
07501-2328
US

IV. Provider business mailing address

107 PARK AVE
PATERSON NJ
07501-2328
US

V. Phone/Fax

Practice location:
  • Phone: 973-928-8888
  • Fax: 973-742-0806
Mailing address:
  • Phone: 305-928-8888
  • Fax: 973-742-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00710100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ABDULMAJEED HOZIEN
Title or Position: PHARMACIST
Credential:
Phone: 973-928-8888