Healthcare Provider Details

I. General information

NPI: 1053636043
Provider Name (Legal Business Name): RHN 6200, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 BERGENLINE AVE
WEST NEW YORK NJ
07093-1619
US

IV. Provider business mailing address

6200 BERGENLINE AVE
WEST NEW YORK NJ
07093-1619
US

V. Phone/Fax

Practice location:
  • Phone: 201-861-7521
  • Fax: 201-861-1471
Mailing address:
  • Phone: 201-861-7521
  • Fax: 201-861-1471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00701700
License Number StateNJ

VIII. Authorized Official

Name: MR. RENE DEHOMBRE
Title or Position: PHARMACIST
Credential: R.PH.
Phone: 201-861-7521