Grand Street Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

28RS00751800 Issued in NJ

Legal business name

GRAND STREET PHARMACY LLC

Doing business as

Grand Street Pharmacy
Nikky's Pharmacy LLC

Practice address

351 Grand St
Paterson, NJ 07505-2034

Phone

(973) 374-6480

Fax

(973) 374-6730

NPI assigned

Jun 26, 2016

Last updated

Apr 4, 2022By 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

Mr. Ramesh Gajjar

Title

Owener

Phone

(973) 898-9800

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• Grand Street Pharmacy Doing business as
• Nikky's Pharmacy LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

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

{
    "created_epoch": "1466899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649030400000",
    "number": "1366893851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 GRAND ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075052034",
            "telephone_number": "973-898-9800",
            "fax_number": "973-379-9067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 GRAND ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075052034",
            "telephone_number": "973-374-6480",
            "fax_number": "973-374-6730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND STREET PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-26",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A",
        "authorized_official_last_name": "GAJJAR",
        "authorized_official_first_name": "RAMESH",
        "authorized_official_title_or_position": "OWENER",
        "authorized_official_telephone_number": "973-898-9800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NJ",
            "license": "28RS00751800",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2165963",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Street Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nikky's Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pharmacy in Paterson, NJ
• Providers in Paterson, NJ by specialty
• Pharmacy in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.