| NPI | 1619498300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAVIER PONCE Owner 973-482-7007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NJ 25MD00246800) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2019-05-22 |