St Paul Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

ST PAUL PHARMACY LLC

Practice address

123 Grove St
Montclair, NJ 07042-4021

Phone

(718) 210-6113

NPI assigned

May 25, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wael Nabil Isaac

Title

Owner

Phone

(718) 210-6113

Specialties & licenses 4

Addresses

Other names 1

• Grove pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740614400000",
    "number": "1083454359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 GROVE ST",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070424092",
            "telephone_number": "718-210-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 GROVE ST",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070424021",
            "telephone_number": "718-210-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST PAUL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-25",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A",
        "authorized_official_last_name": "ISAAC",
        "authorized_official_first_name": "WAEL",
        "authorized_official_middle_name": "NABIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-210-6113"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grove pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Stepan Staffen, LMT
• Leigh Ann Stagliano Tedesco, LCSW
• Jennifer Lorraine Stang, L.AC
• Allison Susan Stanton, LCSW

• Community/Retail Pharmacy in Montclair, NJ
• Providers in Montclair, NJ by specialty
• Community/Retail Pharmacy in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.