Jea Ava Maria LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

JEA AVA MARIA LLC

Practice address

203 Main St
Boonton, NJ 07005-1749

Phone

(973) 334-0519

Fax

(973) 334-9390

NPI assigned

Sep 2, 2021

Organization subpart

No

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

Authorized official

Name

John GhalyNPI 1699276915

Title

Managing Member

Phone

(973) 334-0519

Specialties & licenses 1

Addresses

Other names 1

• MAIN PHARMACY Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Ghaly, RPH

  • Pharmacist
  • Randolph, NJ
  • NPI 1699276915
  NPD Authorized official

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

{
    "created_epoch": "1630540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630540800000",
    "number": "1457029563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 MAIN ST",
            "city": "BOONTON",
            "state": "NJ",
            "postal_code": "070051749",
            "telephone_number": "973-334-0519",
            "fax_number": "973-334-9390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 MAIN ST",
            "city": "BOONTON",
            "state": "NJ",
            "postal_code": "070051749",
            "telephone_number": "973-334-0519",
            "fax_number": "973-334-9390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEA AVA MARIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-02",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "GHALY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "973-334-0519"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAIN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Boonton, NJ
• Providers in Boonton, 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, 2021; 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.