Provider Demographics
NPI:1285388595
Name:ST MARY & ST MOSES PHARMACY
Entity type:Organization
Organization Name:ST MARY & ST MOSES PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NADY
Authorized Official - Middle Name:
Authorized Official - Last Name:AZER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-792-9881
Mailing Address - Street 1:30 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4674
Mailing Address - Country:US
Mailing Address - Phone:201-455-4785
Mailing Address - Fax:
Practice Address - Street 1:875 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4405
Practice Address - Country:US
Practice Address - Phone:201-792-9881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-06
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy