Healthcare Provider Details

I. General information

NPI: 1407781842
Provider Name (Legal Business Name): SUPREME PROPERTIES LLC, D/B/A GRACEFUL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 RTE 37 W
TOMS RIVER NJ
08755-5054
US

IV. Provider business mailing address

62 HARRISON AVE
EDISON NJ
08837-3428
US

V. Phone/Fax

Practice location:
  • Phone: 864-320-0088
  • 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: MAYKIL HAROUN
Title or Position: PRESIDENT/MANAGER
Credential:
Phone: 864-320-0088