Provider Demographics
NPI:1497050694
Name:GAURI PHARMACY INC
Entity Type:Organization
Organization Name:GAURI PHARMACY INC
Other - Org Name:SOUTH BROAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/STAFF RPH
Authorized Official - Prefix:
Authorized Official - First Name:UMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-887-4405
Mailing Address - Street 1:82 OLIVER RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3729
Mailing Address - Country:US
Mailing Address - Phone:201-887-4405
Mailing Address - Fax:
Practice Address - Street 1:530 WESTFIELD AVE FL 1
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1623
Practice Address - Country:US
Practice Address - Phone:908-469-4061
Practice Address - Fax:908-469-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007098003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0279293Medicaid
3197591OtherNCPDP PROVIDER IDENTIFICATION NUMBER