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General NPI Number Information
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NPI Number | 1528089596
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Entity Type | Organization
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Legal Business Name | SOUTH BROAD DRUGS INC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 1094 BROAD ST
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City | NEWARK
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State | NJ
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Zip | 07114-2004
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Country | US
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Telephone | 973-824-3929
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Fax | 973-824-9446
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Provider Business Mailing Address
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Address Line | 1094 BROAD ST
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City | NEWARK
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State | NJ
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Zip | 07114-2004
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Country | US
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Telephone | 973-824-3929
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Fax | 973-824-9446
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Authorized Official
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Title or Position | SUPERVISING RPH
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Name | VINODRAI SHAH
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Credential | RPH
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Telephone | 973-824-3929
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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 | 28RS00358500
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License Number State | NJ
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