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General NPI Number Information
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NPI Number | 1356426845
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Entity Type | Organization
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Legal Business Name | FERNIK, LLC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 475 BRACE AVE
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3018
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Country | US
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Telephone | 732-442-6442
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Fax | 732-442-5784
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Provider Business Mailing Address
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Address Line | 475 BRACE AVE
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3018
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Country | US
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Telephone | 732-442-6442
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Fax | 732-442-5784
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Authorized Official
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Title or Position | OWNER
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Name | MR. FERNANDO OLIVEIRA
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Credential |
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Telephone | 732-442-6442
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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 | RS00667200
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License Number State | NJ
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