=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912052861
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL CENTER PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 11/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 339 N ROUTE 73
-----------------------------------------------------
City | TANSBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08009-9707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-767-6663
-----------------------------------------------------
Fax | 856-767-8088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 339 N ROUTE 73, TANSBORO
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08009-9707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-767-6663
-----------------------------------------------------
Fax | 856-767-8088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. BILAL ALSUBAI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-767-6663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------