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General NPI Number Information
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NPI Number | 1073592713
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Entity Type | Organization
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Legal Business Name | MEDI CENTER PHARMACY
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 993 MCBRIDE AVE
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City | WEST PATERSON
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State | NJ
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Zip | 07424-2534
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Country | US
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Telephone | 973-256-0144
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Fax |
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Provider Business Mailing Address
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Address Line | 993 MCBRIDE AVE
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City | WEST PATERSON
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State | NJ
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Zip | 07424-2534
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Country | US
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Telephone | 973-256-0144
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MISS LINA DIAZ
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Credential | R.P.
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Telephone | 973-256-0144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 28RS00615700
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License Number State | NJ
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