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General NPI Number Information
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NPI Number | 1477231280
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Entity Type | Organization
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Legal Business Name | BROAD ST PHARMACY LLC
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 1285 BROAD ST STE 3
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-3045
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Country | US
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Telephone | 973-893-5957
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Fax | 973-893-5937
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Provider Business Mailing Address
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Address Line | 1285 BROAD ST STE 3
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-3045
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Country | US
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Telephone | 973-893-5957
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Fax | 973-893-5937
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Authorized Official
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Title or Position | OWNER
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Name | SHEREEN BADER
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Credential |
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Telephone | 973-851-1367
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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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