Provider Demographics
NPI:1538656582
Name:EZ PHARMACY INC
Entity Type:Organization
Organization Name:EZ PHARMACY INC
Other - Org Name:PHARMACY PLUS & SURGICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ILYASOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-968-5260
Mailing Address - Street 1:57 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3555
Mailing Address - Country:US
Mailing Address - Phone:201-968-5260
Mailing Address - Fax:
Practice Address - Street 1:57 LINDEN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-968-5960
Practice Address - Fax:201-968-5261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007639003336C0003X
NJ3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy