Provider Demographics
NPI:1679685671
Name:AMIREH CORPORATION
Entity Type:Organization
Organization Name:AMIREH CORPORATION
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIREH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-239-3339
Mailing Address - Street 1:792 POMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:792 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1229
Practice Address - Country:US
Practice Address - Phone:973-239-3339
Practice Address - Fax:973-239-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS00514000333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6530508Medicaid
3101247OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NJ6530516Medicaid
NJ6530516Medicaid
NJ6530516Medicaid