Provider Demographics
NPI:1770810574
Name:FENNY I PHARMACY LLC
Entity type:Organization
Organization Name:FENNY I PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:BPHARM
Authorized Official - Phone:646-417-3844
Mailing Address - Street 1:1 COMMANDERS CT
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2197
Mailing Address - Country:US
Mailing Address - Phone:646-417-3844
Mailing Address - Fax:973-371-2247
Practice Address - Street 1:362 MONROE ST # C
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4114
Practice Address - Country:US
Practice Address - Phone:973-928-2230
Practice Address - Fax:973-928-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006989003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122413OtherPK