Provider Demographics
NPI:1912565169
Name:TESH M II LLC
Entity Type:Organization
Organization Name:TESH M II LLC
Other - Org Name:CITY PHARMACY OF NUTLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GHARIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-667-6677
Mailing Address - Street 1:215 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2708
Mailing Address - Country:US
Mailing Address - Phone:973-667-6677
Mailing Address - Fax:973-667-6675
Practice Address - Street 1:215 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2708
Practice Address - Country:US
Practice Address - Phone:973-667-6677
Practice Address - Fax:973-667-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0713775Medicaid