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General NPI Number Information
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NPI Number | 1609949544
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Entity Type | Organization
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Legal Business Name | DIAMOND BRIDGE PHARMACY LLC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 293 LAFAYETTE AVE STE 100
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City | HAWTHORNE
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State | NJ
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Zip | 07506-2033
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Country | US
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Telephone | 973-427-1234
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Fax | 973-427-6624
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Provider Business Mailing Address
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Address Line | 293 LAFAYETTE AVE STE 100
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City | HAWTHORNE
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State | NJ
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Zip | 07506-2033
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Country | US
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Telephone | 973-427-1234
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Fax | 973-427-6624
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | ARCHIT PATEL
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Credential |
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Telephone | 973-722-6664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00372200
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License Number State | NJ
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