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General NPI Number Information
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NPI Number | 1477684645
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Entity Type | Organization
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Legal Business Name | SHALOM PHARMACY INC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 525 ELIZABETH AVE
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City | NEWARK
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State | NJ
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Zip | 07112-2584
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Country | US
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Telephone | 973-926-9300
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Fax | 973-926-9338
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Provider Business Mailing Address
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Address Line | 525 ELIZABETH AVE
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City | NEWARK
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State | NJ
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Zip | 07112-2584
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Country | US
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Telephone | 973-926-9300
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Fax | 973-926-9338
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Authorized Official
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Title or Position | OWNER
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Name | MS. CHRISTIE OGUN
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Credential | PHARMACIST
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Telephone | 973-926-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI02541100
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License Number State | NJ
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