Healthcare Provider Details

I. General information

NPI: 1922561646
Provider Name (Legal Business Name): NJ PHARMALOGICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 BERGENLINE AVE
UNION CITY NJ
07087-4775
US

IV. Provider business mailing address

3510 BERGENLINE AVE
UNION CITY NJ
07087-4775
US

V. Phone/Fax

Practice location:
  • Phone: 201-500-9366
  • Fax: 201-500-9367
Mailing address:
  • Phone: 201-500-9366
  • Fax: 201-500-9367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY GRACIANO
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D
Phone: 201-577-2313