Healthcare Provider Details

I. General information

NPI: 1518227347
Provider Name (Legal Business Name): POMPTON PHARMACY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2012
Last Update Date: 05/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 HAMBURG TPKE
POMPTON LAKES NJ
07442-1434
US

IV. Provider business mailing address

720 HAMBURG TPKE
POMPTON LAKES NJ
07442-1434
US

V. Phone/Fax

Practice location:
  • Phone: 973-907-7440
  • Fax: 973-907-7441
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00719300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number28RS00719300
License Number StateNJ

VIII. Authorized Official

Name: NAHED AHMED
Title or Position: PRESIDENT
Credential:
Phone: 973-409-1374