=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467707281
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMISWET E-Z LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2012
-----------------------------------------------------
Last Update Date | 07/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1018 US HIGHWAY 9 1018 US HIGHWAY 9 ,OLD BRIDGE GATEWAY SHOPPING CENTER
-----------------------------------------------------
City | PARLIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08859-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-561-3339
-----------------------------------------------------
Fax | 732-561-3340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1018 US HIGHWAY 9 E-Z HEALTHMART PHARMACY
-----------------------------------------------------
City | PARLIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08859-1401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-561-3339
-----------------------------------------------------
Fax | 732-561-3340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO/ OWNER
-----------------------------------------------------
Name | MRS. EMILY NKECHI ONYEKWELU
-----------------------------------------------------
Credential | PHARMACIST
-----------------------------------------------------
Telephone | 732-561-3339
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28I03486600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------