Provider Demographics
NPI:1982284055
Name:ST KEROLLOS PHARMACY INC.
Entity Type:Organization
Organization Name:ST KEROLLOS PHARMACY INC.
Other - Org Name:GALAXY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-339-2508
Mailing Address - Street 1:220 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2754
Mailing Address - Country:US
Mailing Address - Phone:201-984-0566
Mailing Address - Fax:201-984-2102
Practice Address - Street 1:220 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2754
Practice Address - Country:US
Practice Address - Phone:201-984-0566
Practice Address - Fax:201-984-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00783600OtherSTATE LICENSE