Healthcare Provider Details

I. General information

NPI: 1245245869
Provider Name (Legal Business Name): SAINT MARY AND JESSIE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 SMITH ST
PERTH AMBOY NJ
08861-4042
US

IV. Provider business mailing address

288 SMITH ST
PERTH AMBOY NJ
08861-4042
US

V. Phone/Fax

Practice location:
  • Phone: 732-324-4490
  • Fax: 732-324-4491
Mailing address:
  • Phone: 732-324-4490
  • Fax: 732-324-4491

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 Number28RS00645500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ASHRAF DAWOD
Title or Position: OWNER
Credential:
Phone: 732-324-4490