1497050694 NPI number — GAURI PHARMACY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497050694 NPI number — GAURI PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAURI PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTH BROAD PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497050694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
82 OLIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARAMUS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07652-3729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-887-4405
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 WESTFIELD AVE FL 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07208-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-469-4061
Provider Business Practice Location Address Fax Number:
908-469-4063
Provider Enumeration Date:
01/19/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
UMESH
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/STAFF RPH
Authorized Official Telephone Number:
201-887-4405

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  28RS00709800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0279293 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3197591 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".