Provider Demographics
NPI:1821897380
Name:PASSAIC PHARMACY AND MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:PASSAIC PHARMACY AND MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:LOBNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-259-0115
Mailing Address - Street 1:81 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:156 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-7392
Practice Address - Country:US
Practice Address - Phone:908-382-0158
Practice Address - Fax:908-382-0156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PASSAIC PHARMACY AND MEDICAL SUPPLIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy