Provider Demographics
NPI:1720860380
Name:UPTOWN PHARMACY LLC
Entity Type:Organization
Organization Name:UPTOWN PHARMACY LLC
Other - Org Name:UPTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-360-0772
Mailing Address - Street 1:3238 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3419
Mailing Address - Country:US
Mailing Address - Phone:201-360-0772
Mailing Address - Fax:201-360-0817
Practice Address - Street 1:3238 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3419
Practice Address - Country:US
Practice Address - Phone:201-360-0772
Practice Address - Fax:201-360-0817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy