Provider Demographics
NPI:1245759067
Name:D AND D PHARMACY
Entity Type:Organization
Organization Name:D AND D PHARMACY
Other - Org Name:OCEANPORT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERVAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-542-8607
Mailing Address - Street 1:271 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1145
Mailing Address - Country:US
Mailing Address - Phone:732-542-8607
Mailing Address - Fax:
Practice Address - Street 1:271 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1145
Practice Address - Country:US
Practice Address - Phone:732-542-8607
Practice Address - Fax:732-389-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00613900333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9034714Medicaid