Provider Demographics
NPI:1174305569
Name:BLUE GOOSE PHARMACY GROUP LLC
Entity type:Organization
Organization Name:BLUE GOOSE PHARMACY GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-867-5153
Mailing Address - Street 1:1500 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-1922
Mailing Address - Country:US
Mailing Address - Phone:551-587-2211
Mailing Address - Fax:
Practice Address - Street 1:1500 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-1922
Practice Address - Country:US
Practice Address - Phone:551-587-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy