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General NPI Number Information
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NPI Number | 1922507656
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Entity Type | Organization
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Legal Business Name | MAIN STREET RX
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Dates
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Enumeration Date | 02/08/2018
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 764 MAIN ST
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City | PATERSON
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State | NJ
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Zip | 07503-2640
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Country | US
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Telephone | 973-278-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 764 MAIN ST
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City | PATERSON
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State | NJ
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Zip | 07503-2640
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Country | US
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Telephone | 973-278-9000
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Fax | 973-278-9002
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | DR. YOUSEF BARKAWI
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Credential | PHARMD
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Telephone | 973-278-0000
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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 | 28RS00760200
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License Number State | NJ
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