Provider Demographics
NPI:1356116495
Name:MJ'S MODERN PHARMACY
Entity type:Organization
Organization Name:MJ'S MODERN PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:H
Authorized Official - Last Name:MIQBEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:551-556-4731
Mailing Address - Street 1:1402 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-1936
Mailing Address - Country:US
Mailing Address - Phone:201-353-0007
Mailing Address - Fax:201-353-0008
Practice Address - Street 1:1402 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-1936
Practice Address - Country:US
Practice Address - Phone:551-556-4731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy