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General NPI Number Information
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NPI Number | 1982109880
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Entity Type | Organization
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Legal Business Name | DIFFERX PHARMACY LLC
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Dates
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Enumeration Date | 03/24/2018
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 492 CENTRAL AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07307-2646
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Country | US
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Telephone | 201-716-2568
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Fax | 201-221-8357
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Provider Business Mailing Address
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Address Line | 492 CENTRAL AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07307-2646
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Country | US
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Telephone | 201-716-2568
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Fax | 201-221-8357
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUSTIN HUYNH
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Credential |
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Telephone | 201-716-2568
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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 |
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License Number State |
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