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FOURTH AVE PHARMACY LLC NPI 1225130354


NPI Information

NPI: 1225130354
Provider Name: FOURTH AVE PHARMACY LLC

Doing Business As: FOURTH AVENUE PHARMACY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 31D2211228

Address:
329 ROSEVILLE AVE
NEWARK, NJ
ZIP 07107
Phone: (973) 483-3872
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FOURTH AVE PHARMACY LLC is a community/retail pharmacy pharmacy in Newark, NJ. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. FOURTH AVE PHARMACY LLC NPI is 1225130354. The provider is registered as an organization entity type.
The provider Is Doing Business As Fourth Avenue Pharmacy.

The provider's business location address is:

329 ROSEVILLE AVE
NEWARK, NJ
ZIP 07107-757
Phone: (973) 483-3872
Fax: (973) 483-6956

The provider's authorized official is Ayush Gajera .
The authorized official title is Pharmacist and has the following contact phone number (973) 483-3872.

The CLIA number assigned to this NPI record is 31D2211228 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/1/2006 and was last updated on 4/19/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
13336S0011XPharmacySpecialty PharmacyNo
2332B00000XDurable Medical Equipment & Medical SuppliesNo
3333600000XPharmacyNo
43336C0003XPharmacyCommunity/Retail Pharmacy28RS00335200NEW JERSEYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
16653650001MEDICARE NSC
22132840OTHERPK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.