Provider Demographics
NPI:1770011371
Name:APOLLO PHARMACY INC
Entity Type:Organization
Organization Name:APOLLO PHARMACY INC
Other - Org Name:APOLLO PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BHAVESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJERA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-350-6155
Mailing Address - Street 1:130 SUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1903
Mailing Address - Country:US
Mailing Address - Phone:973-350-6155
Mailing Address - Fax:973-556-1560
Practice Address - Street 1:130 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1903
Practice Address - Country:US
Practice Address - Phone:973-350-6155
Practice Address - Fax:973-556-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007565003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169039OtherPK
NJ0605476Medicaid
2169039OtherPK