=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245730464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCRIPT SAVERS PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2018
-----------------------------------------------------
Last Update Date | 02/14/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 737 BROADWAY
-----------------------------------------------------
City | BAYONNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07002-3942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-436-7283
-----------------------------------------------------
Fax | 201-436-0999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 ALEXANDER CT
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07305-5514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-401-0702
-----------------------------------------------------
Fax | 201-436-0999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST-IN-CHARGE
-----------------------------------------------------
Name | AMIR TADROS
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 201-401-0702
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28RS00760000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------