Provider Demographics
NPI:1437573052
Name:JERRY'S DRUG & SURGICAL
Entity Type:Organization
Organization Name:JERRY'S DRUG & SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELIKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-725-8951
Mailing Address - Street 1:455 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-7112
Mailing Address - Country:US
Mailing Address - Phone:201-725-8951
Mailing Address - Fax:
Practice Address - Street 1:455 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-7112
Practice Address - Country:US
Practice Address - Phone:201-725-8951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI023519003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy