Provider Demographics
NPI:1134829773
Name:BERGEN ROAD PHARMACY
Entity type:Organization
Organization Name:BERGEN ROAD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:917-224-1652
Mailing Address - Street 1:239 OLD BERGEN RD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2620
Mailing Address - Country:US
Mailing Address - Phone:201-434-8062
Mailing Address - Fax:201-434-7596
Practice Address - Street 1:239 OLD BERGEN RD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2620
Practice Address - Country:US
Practice Address - Phone:201-994-4065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies