MEDICARE: SUPREME PROPERTIES LLC, D/B/A GRACEFUL PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1407781842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPREME PROPERTIES LLC, D/B/A GRACEFUL PHARMACY

Provider Business Mailing Address
First Line	:	62 HARRISON AVE
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08837-3428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	941 RTE 37 W
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-5054
Country	:	US
Telephone Number	:	864-320-0088
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/MANAGER
Name	:	MAYKIL HAROUN
Credential	:
Telephone Number	:	864-320-0088

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “SUPREME PROPERTIES LLC, D/B/A GRACEFUL PHARMACY ” Practice Location

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