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General NPI Number Information
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NPI Number | 1902329808
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Entity Type | Organization
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Legal Business Name | BLOOMFIELD PHARMACY LLC
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Dates
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Enumeration Date | 07/23/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 594B BLOOMFIELD AVE
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-2510
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Country | US
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Telephone | 484-358-2118
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Fax |
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Provider Business Mailing Address
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Address Line | 594B BLOOMFIELD AVE
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-2510
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Country | US
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Telephone | 484-358-2118
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. HOSSAM FARAG
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Credential |
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Telephone | 484-358-2118
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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 | 28RS00757600
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License Number State | NJ
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