Healthcare Provider Details

I. General information

NPI: 1073592713
Provider Name (Legal Business Name): MEDI CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 MCBRIDE AVE
WEST PATERSON NJ
07424-2534
US

IV. Provider business mailing address

993 MCBRIDE AVE
WEST PATERSON NJ
07424-2534
US

V. Phone/Fax

Practice location:
  • Phone: 973-256-0144
  • Fax:
Mailing address:
  • Phone: 973-256-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00615700
License Number StateNJ

VIII. Authorized Official

Name: MISS LINA DIAZ
Title or Position: MANAGER
Credential: R.P.
Phone: 973-256-0144