Healthcare Provider Details

I. General information

NPI: 1790140192
Provider Name (Legal Business Name): SG HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S OLDEN AVE
TRENTON NJ
08629-2102
US

IV. Provider business mailing address

503 S OLDEN AVE
TRENTON NJ
08629-2102
US

V. Phone/Fax

Practice location:
  • Phone: 609-337-7152
  • Fax: 609-337-7153
Mailing address:
  • Phone: 609-337-7152
  • Fax: 609-337-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00747700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SEDEF GULSAN
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 267-980-9444