Main Avenue Pharmacy Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MAIN AVENUE PHARMACY CORP

Practice address

1094 Main Ave Ste a
Clifton, NJ 07011-2384

Phone

(973) 928-0208

NPI assigned

May 11, 2011

Last updated

Sep 2, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nanci Lieneck

Title

Operations Manager

Phone

(973) 928-0208

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441152000000",
    "number": "1255623112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1094 MAIN AVE STE A",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070112384",
            "telephone_number": "973-928-0208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1094 MAIN AVE STE A",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070112384",
            "telephone_number": "973-928-0208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN AVENUE PHARMACY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-11",
        "last_updated": "2015-09-02",
        "status": "A",
        "authorized_official_last_name": "LIENECK",
        "authorized_official_first_name": "NANCI",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "973-928-0208"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "276006",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ahmad F Mahmoud, M.D.
• Rana Mahmoud
• Ronda Sami Mahmoud, ANP
• Maimone Vision Associates, LLC
• Main Avenue Clifton Surgery Center, LLC
• Main Medical Imaging Center
• Main Plaza Pharmacy LLC
• Maincure Pharmacy LLC
• Theodora J Maio, M.D.
• Laura Majewski, LSW

• Community/Retail Pharmacy in Clifton, NJ
• Providers in Clifton, 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 Sep 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.