Provider Demographics
NPI:1154089282
Name:CONCORD PHARMACY LLC
Entity Type:Organization
Organization Name:CONCORD PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHAMALLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-993-0978
Mailing Address - Street 1:317 MARTIN LUTHER KING DR.
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305
Mailing Address - Country:US
Mailing Address - Phone:201-685-7070
Mailing Address - Fax:201-685-7656
Practice Address - Street 1:317 MARTIN LUTHER KING DR.
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305
Practice Address - Country:US
Practice Address - Phone:201-685-7070
Practice Address - Fax:201-685-7656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00786900OtherPHARMACY STATE LICENSE