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General NPI Number Information
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NPI Number | 1952721847
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Entity Type | Organization
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Legal Business Name | ST PETER PHARMACY
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Dates
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Enumeration Date | 04/18/2014
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 15-17 ROPES PL #106
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City | NEWARK
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State | NJ
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Zip | 07107-4803
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Country | US
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Telephone | 862-240-9311
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Fax | 862-240-9310
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Provider Business Mailing Address
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Address Line | 15-17 ROPES PL
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City | NEWARK
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State | NJ
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Zip | 07107-4803
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Country | US
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Telephone | 862-240-9311
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Fax | 862-240-9310
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Authorized Official
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Title or Position | MEMBER
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Name | PETER MASSAK
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Credential |
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Telephone | 862-240-9311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00732800
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License Number State | NJ
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