Provider Demographics
NPI:1154834729
Name:FABIOS PHARMACY 2 LLC
Entity Type:Organization
Organization Name:FABIOS PHARMACY 2 LLC
Other - Org Name:FABIOS PHARMACY 2 LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:FABIO
Authorized Official - Last Name:JAIME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-421-9663
Mailing Address - Street 1:10 WENTICK ST
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2415
Mailing Address - Country:US
Mailing Address - Phone:201-421-9663
Mailing Address - Fax:
Practice Address - Street 1:3413 BERGENLINE AVE FL 1
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3921
Practice Address - Country:US
Practice Address - Phone:201-721-9663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy