| NPI | 1295950350 |
|---|---|
| Doing Business As | SUPER FRESH PHARMACY # 804 |
| Entity Type | Organization |
| Authorized Contact | CAROL J. DINICOLANTONIO Sr. Director, Pharmacy 201-571-8334 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: PA PP481110) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: PA PP481110) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: PA PP481110) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-11-14 |