Provider Demographics
NPI:1316446594
Name:CLIFTON PHARMACY RX LLC
Entity type:Organization
Organization Name:CLIFTON PHARMACY RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/AO
Authorized Official - Prefix:
Authorized Official - First Name:USMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANVIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-225-9726
Mailing Address - Street 1:261 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1842
Mailing Address - Country:US
Mailing Address - Phone:862-225-9726
Mailing Address - Fax:862-225-9728
Practice Address - Street 1:261 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1842
Practice Address - Country:US
Practice Address - Phone:862-225-9726
Practice Address - Fax:862-225-9728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X, 333600000X
NJ28RS007612003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175884OtherPK