Provider Demographics
NPI:1497052245
Name:PARK AVE DRUGS LLC
Entity Type:Organization
Organization Name:PARK AVE DRUGS LLC
Other - Org Name:PARK AVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ABDULMAJEED
Authorized Official - Middle Name:
Authorized Official - Last Name:HOZIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-928-8888
Mailing Address - Street 1:107 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-2328
Mailing Address - Country:US
Mailing Address - Phone:305-928-8888
Mailing Address - Fax:973-742-0806
Practice Address - Street 1:107 PARK AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2328
Practice Address - Country:US
Practice Address - Phone:973-928-8888
Practice Address - Fax:973-742-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NJ28RS007101003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0276014Medicaid
2128921OtherPK
2128921OtherPK