Provider Demographics
NPI:1982756524
Name:MONTGOMERY PHARMACY INC
Entity Type:Organization
Organization Name:MONTGOMERY PHARMACY INC
Other - Org Name:MONTGOMERY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MUKHTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-333-8999
Mailing Address - Street 1:450 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-3224
Mailing Address - Country:US
Mailing Address - Phone:201-333-8999
Mailing Address - Fax:201-333-0018
Practice Address - Street 1:450 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-3224
Practice Address - Country:US
Practice Address - Phone:201-333-8999
Practice Address - Fax:201-333-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS005446200333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4836920001Medicare NSC