Provider Demographics
NPI:1194367987
Name:BLOOMING HEALTH LLC
Entity Type:Organization
Organization Name:BLOOMING HEALTH LLC
Other - Org Name:PARK RIDGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMGAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-886-2253
Mailing Address - Street 1:40 PARK AVE, STORE # 5
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1724
Mailing Address - Country:US
Mailing Address - Phone:914-886-2253
Mailing Address - Fax:
Practice Address - Street 1:40 PARK AVE, STORE # 5
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-0765
Practice Address - Country:US
Practice Address - Phone:201-554-2200
Practice Address - Fax:201-554-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-13
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy