Provider Demographics
NPI:1962757864
Name:CENTURY PHARMACY LLC
Entity type:Organization
Organization Name:CENTURY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIPISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-261-6479
Mailing Address - Street 1:37 W CENTURY RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1409
Mailing Address - Country:US
Mailing Address - Phone:201-261-6479
Mailing Address - Fax:201-261-9479
Practice Address - Street 1:37 W CENTURY RD
Practice Address - Street 2:SUITE 113
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1409
Practice Address - Country:US
Practice Address - Phone:201-261-6479
Practice Address - Fax:201-261-9479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007202003336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy