Provider Demographics
NPI:1144430513
Name:JILL PHARMACY CORP.
Entity type:Organization
Organization Name:JILL PHARMACY CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-444-4190
Mailing Address - Street 1:191 ROCK RD
Mailing Address - Street 2:PO BOX 605
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1706
Mailing Address - Country:US
Mailing Address - Phone:201-444-4190
Mailing Address - Fax:201-444-2698
Practice Address - Street 1:191 ROCK RD
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1706
Practice Address - Country:US
Practice Address - Phone:201-444-4190
Practice Address - Fax:201-444-2698
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JILL PHARMACY CORP. DBA ROCK RIDGE PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-23
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS004873003336C0004X
NJ3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy