Provider Demographics
NPI:1184297400
Name:UNIVERSITY PLACE PHARMACY LLC
Entity type:Organization
Organization Name:UNIVERSITY PLACE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-559-1440
Mailing Address - Street 1:23 UNIVERSITY PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-3188
Mailing Address - Country:US
Mailing Address - Phone:201-559-1440
Mailing Address - Fax:
Practice Address - Street 1:23 UNIVERSITY PLACE BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-3188
Practice Address - Country:US
Practice Address - Phone:201-559-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy