=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245759067
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D AND D PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 271 E MAIN ST
-----------------------------------------------------
City | OCEANPORT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07757-1145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-542-8607
-----------------------------------------------------
Fax | 732-389-9022
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 271 E MAIN ST
-----------------------------------------------------
City | OCEANPORT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07757-1145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-542-8607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MERVAT GIRGIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-542-8607
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 28RS00613900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------