Provider Demographics
NPI:1487456828
Name:JERSEY APOTHECARY INC
Entity type:Organization
Organization Name:JERSEY APOTHECARY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-656-4392
Mailing Address - Street 1:286 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3090
Mailing Address - Country:US
Mailing Address - Phone:201-656-4392
Mailing Address - Fax:201-420-8399
Practice Address - Street 1:286 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3090
Practice Address - Country:US
Practice Address - Phone:201-656-4392
Practice Address - Fax:201-420-8399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JERSEY APOTHECARY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy