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General NPI Number Information
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NPI Number | 1366893851
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Entity Type | Organization
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Legal Business Name | GRAND STREET PHARMACY LLC
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Dates
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Enumeration Date | 06/26/2016
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 351 GRAND ST
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City | PATERSON
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State | NJ
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Zip | 07505-2034
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Country | US
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Telephone | 973-374-6480
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Fax | 973-374-6730
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Provider Business Mailing Address
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Address Line | 351 GRAND ST
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City | PATERSON
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State | NJ
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Zip | 07505-2034
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Country | US
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Telephone | 973-898-9800
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Fax | 973-379-9067
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Authorized Official
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Title or Position | OWENER
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Name | MR. RAMESH GAJJAR
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Credential |
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Telephone | 973-898-9800
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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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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 28RS00751800
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License Number State | NJ
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