=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457451783
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FEINSTEINS PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 295 16TH AVE
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07103-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-372-1894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 295 16TH AVE
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07103-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-372-1894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RICHARD DEFILIPPO
-----------------------------------------------------
Credential | R.P.
-----------------------------------------------------
Telephone | 973-372-1894
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 28RS00519200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------