Provider Demographics
NPI:1386392405
Name:JERSEY MEDS PHARMACY INC
Entity type:Organization
Organization Name:JERSEY MEDS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:YAMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEHADEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-668-1040
Mailing Address - Street 1:15 VROOM ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 VROOM ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2006
Practice Address - Country:US
Practice Address - Phone:201-668-1040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy