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General NPI Number Information
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NPI Number | 1760803019
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Entity Type | Organization
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Legal Business Name | TRISTATE WELLNESS PHARMACY
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 01/08/2014
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Provider Practice Location Address
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Address Line | 290 DUNHAMS CORNER ROAD
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816
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Country | US
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Telephone | 908-421-3738
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Fax |
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Provider Business Mailing Address
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Address Line | 51 BRUNSWICK WOODS DRIVE
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | BASSEM GIRGIS
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Credential |
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Telephone | 908-421-3738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty 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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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