Provider Demographics
NPI:1407619505
Name:RANCH HEALTH JERSEY CITY LLC
Entity Type:Organization
Organization Name:RANCH HEALTH JERSEY CITY LLC
Other - Org Name:123 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER, PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-389-1216
Mailing Address - Street 1:420 GRAND ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 GRAND ST UNIT 101
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4240
Practice Address - Country:US
Practice Address - Phone:908-325-9084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy