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General NPI Number Information
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NPI Number | 1699241471
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Entity Type | Organization
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Legal Business Name | MAIN RX PHARMACY LLC
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 10/18/2018
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Provider Practice Location Address
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Address Line | 594 MAIN AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-4907
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Country | US
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Telephone | 973-732-7702
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Fax | 973-732-3077
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Provider Business Mailing Address
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Address Line | 594 MAIN AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-4907
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Country | US
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Telephone | 973-732-7702
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Fax | 973-732-3077
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Authorized Official
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Title or Position | MEMBER
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Name | HASSAM LATIF
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Credential |
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Telephone | 973-732-7702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 |
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License Number State |
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