Provider Demographics
NPI:1003461922
Name:THE SQUARE PHARMACY LLC
Entity Type:Organization
Organization Name:THE SQUARE PHARMACY LLC
Other - Org Name:THE SQUARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SHAIRYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANKHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-431-7717
Mailing Address - Street 1:30 JOURNAL SQUARE PLZ
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3847
Mailing Address - Country:US
Mailing Address - Phone:201-431-7717
Mailing Address - Fax:
Practice Address - Street 1:30 JOURNAL SQUARE PLZ
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3847
Practice Address - Country:US
Practice Address - Phone:201-431-7717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy