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NPI Code Detail

MEDICARE: FENNY I PHARMACY LLC

MEDICARE: FENNY I PHARMACY 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
13336C0003XCommunity/Retail Pharmacy28RS00698900NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12122413OTHERPK

General Provider Information

NPI Number : 1770810574
Entity Type Code : Organization
Provider Name (Legal Business Name) : FENNY I PHARMACY LLC
Provider Business Mailing Address
First Line : 1 COMMANDERS CT
Second Line :
City : TOTOWA
State : NJ
Zip : 07512-2197
Country : US
Telephone Number : 646-417-3844
Fax Number : 973-371-2247
Provider Business Practice Location Address
First Line : 362 MONROE ST # C
Second Line :
City : PASSAIC
State : NJ
Zip : 07055-4114
Country : US
Telephone Number : 973-928-2230
Fax Number : 973-928-2269
Authorized Official
Title or Position : PRESIDENT
Name : PARESH GANDHI
Credential : B.PHARM
Telephone Number : 646-417-3844
Provider Enumeration Date : 11/16/2009
Last Update Date : 03/03/2016

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