Provider Demographics
NPI:1790840130
Name:ROSE GARDEN NUTRITION INC
Entity type:Organization
Organization Name:ROSE GARDEN NUTRITION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:973-645-0388
Mailing Address - Street 1:P.O. 1660
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-1660
Mailing Address - Country:US
Mailing Address - Phone:973-645-0388
Mailing Address - Fax:973-624-3411
Practice Address - Street 1:22 ELIZABETH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108
Practice Address - Country:US
Practice Address - Phone:973-645-0388
Practice Address - Fax:973-624-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006237003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9106812Medicaid
NJ9106812Medicaid