Healthcare Provider Details

I. General information

NPI: 1417264417
Provider Name (Legal Business Name): HOLIDAY CITY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2010
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 ROUTE 37 W
TOMS RIVER NJ
08755-5038
US

IV. Provider business mailing address

833 ROUTE 37 W
TOMS RIVER NJ
08755-5038
US

V. Phone/Fax

Practice location:
  • Phone: 732-349-3999
  • Fax: 732-349-3900
Mailing address:
  • Phone: 732-349-3999
  • Fax: 732-349-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00708200
License Number StateNJ

VIII. Authorized Official

Name: MR. NAVEEN PARUPALLI
Title or Position: MEMBER
Credential:
Phone: 732-349-3999