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General NPI Number Information
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NPI Number | 1679079131
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Entity Type | Organization
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Legal Business Name | ORGANIX PHARMACY 11 LLC
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 1010 MAIN ST # A2
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City | PATERSON
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State | NJ
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Zip | 07503-2212
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Country | US
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Telephone | 862-336-1013
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 RINGWOOD AVE APT 4
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City | HASKELL
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State | NJ
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Zip | 07420-1457
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Country | US
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Telephone | 973-979-0096
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOAMEN ADEL SALEM
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Credential |
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Telephone | 973-979-0096
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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 | 28RS00760900
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License Number State | NJ
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