Healthcare Provider Details

I. General information

NPI: 1073024931
Provider Name (Legal Business Name): FIVE TOWNS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 ESSEX ST STE 105
ROCHELLE PARK NJ
07662-4347
US

IV. Provider business mailing address

60 ESSEX ST STE 105
ROCHELLE PARK NJ
07662-4347
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-7000
  • Fax: 201-880-7094
Mailing address:
  • Phone: 201-880-7000
  • Fax: 201-880-7094

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 Number28RS00759500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. MEYER DAVIDOFF
Title or Position: CEO
Credential: PHARMD, RPH
Phone: 201-880-7000