=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558593574
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAIRLAWN PHARMACY LIMITED LIABILITY COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2009
-----------------------------------------------------
Last Update Date | 05/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14-25 PLAZA RD
-----------------------------------------------------
City | FAIR LAWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07410-3546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-773-6090
-----------------------------------------------------
Fax | 201-773-6089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14-25 PLAZA RD
-----------------------------------------------------
City | FAIR LAWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07410-3546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-773-6090
-----------------------------------------------------
Fax | 201-773-6089
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | MR. ALEX BEDA
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 201-773-6090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28RS00700100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------