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General NPI Number Information
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NPI Number | 1366505984
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Entity Type | Organization
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Legal Business Name | MIDTOWN PHARMACY
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 02/03/2011
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Provider Practice Location Address
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Address Line | 812 KENNEDY BLVD
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City | BAYONNE
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State | NJ
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Zip | 07002-2809
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Country | US
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Telephone | 201-339-3060
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Fax | 201-339-7177
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Provider Business Mailing Address
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Address Line | 812 KENNEDY BLVD
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City | BAYONNE
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State | NJ
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Zip | 07002-2809
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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 | OWNER
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Name | JOHN SHALHOUB
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Credential |
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Telephone | 201-339-3060
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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 | 28RS00086800
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License Number State | NJ
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