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General NPI Number Information
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NPI Number | 1336665827
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Entity Type | Organization
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Legal Business Name | 110 VAN HOUTEN LLC
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 05/10/2025
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Provider Practice Location Address
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Address Line | 110 VAN HOUTEN AVE
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City | PASSAIC
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State | NJ
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Zip | 07055
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Country | US
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Telephone | 973-955-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 110 VAN HOUTEN AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-4602
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | ASHWIN PATEL
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Credential |
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Telephone | 551-221-5929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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