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General NPI Number Information
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NPI Number | 1386039881
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Entity Type | Organization
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Legal Business Name | SUPER DRUGS LLC
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 03/17/2017
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Provider Practice Location Address
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Address Line | 25 LOCUST AVE
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City | WALLINGTON
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State | NJ
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Zip | 07057-1304
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Country | US
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Telephone | 973-777-4717
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Fax | 973-777-4719
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Provider Business Mailing Address
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Address Line | 25 LOCUST AVE
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City | WALLINGTON
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State | NJ
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Zip | 07057-1304
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Country | US
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Telephone | 973-777-4717
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Fax | 973-777-4719
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | CHIRAG PATEL
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Credential |
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Telephone | 862-215-5208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00739500
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License Number State | NJ
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