Provider Demographics
NPI:1609129733
Name:COMMUNITY PHARMACY & SURGICAL INC
Entity Type:Organization
Organization Name:COMMUNITY PHARMACY & SURGICAL INC
Other - Org Name:COMMUNITY PHARMACY & SURGICAL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-333-4700
Mailing Address - Street 1:79 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-2558
Mailing Address - Country:US
Mailing Address - Phone:201-333-4700
Mailing Address - Fax:
Practice Address - Street 1:79 MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-2558
Practice Address - Country:US
Practice Address - Phone:201-333-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007224003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0367141Medicaid
2137833OtherPK