MEDICARE: FAIRFIELD PHARMACY RX LLC

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	:	1639003346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRFIELD PHARMACY RX LLC

Provider Business Mailing Address
First Line	:	43 LINDEN AVE
Second Line	:
City	:	LINCOLN PARK
State	:	NJ
Zip	:	07035-2545
Country	:	US
Telephone Number	:	862-213-2061
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 HOLLYWOOD AVE STE 4
Second Line	:
City	:	FAIRFIELD
State	:	NJ
Zip	:	07004-2406
Country	:	US
Telephone Number	:	862-213-2061
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHATHA KHALIL
Credential	:
Telephone Number	:	862-213-2061

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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Directions to “FAIRFIELD PHARMACY RX LLC ” Practice Location

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