Provider Demographics
NPI:1033130091
Name:DYLHAR LLC
Entity Type:Organization
Organization Name:DYLHAR LLC
Other - Org Name:LEGACY HEALTH DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NILESH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-845-2210
Mailing Address - Street 1:341 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2517
Mailing Address - Country:US
Mailing Address - Phone:732-845-2210
Mailing Address - Fax:732-294-9480
Practice Address - Street 1:341 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2517
Practice Address - Country:US
Practice Address - Phone:732-845-2210
Practice Address - Fax:732-294-9480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS005746003336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0451533Medicaid
2148389OtherPK
2148389OtherPK