Broad Specialty Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

BROAD SPECIALTY PHARMACY

Doing business as

Broad Specialty Pharmacy

Practice address

737 Broadway
Bayonne, NJ 07002-3942

Phone

(201) 339-2273

NPI assigned

May 18, 2021

Organization subpart

No

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

Authorized official

Name

Fahad Khan

Title

Pharmacist in Charge

Phone

(201) 339-2273

Specialties & licenses 1

Addresses

Other names 1

• Broad Specialty Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Tax ID family

Broad Specialty Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Broad Specialty Pharmacy

  • Long Term Care Pharmacy
  • Bayonne, NJ
  • NPI 1679449045
  NPD tax ID

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• SV Swapna Drugs Inc

  • Community/Retail Pharmacy
  • Cranford, NJ
  • NPI 1851498786

  Member Of

  NPD member

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

{
    "created_epoch": "1621296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646006400000",
    "number": "1508430265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 BROADWAY",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070023942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "737 BROADWAY",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070023942",
            "telephone_number": "201-339-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD SPECIALTY PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-18",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "FAHAD",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "201-339-2273"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broad Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Broad Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Boulevard Medical Office PC
• Mary Ellen Boyle, R.PH.
• Keith Brennan
• Brian C. Della Pesca Ma LPC, LLC
• Telema Briggs, PH.D.
• Broad Specialty Pharmacy
• Broadway Care Pharmacy LLC
• Broadway Chiropractic & Rehabilitation Center
• Broadway Oral Surgery, LLC
• Broadway Physical Therapy, LLC

• Community/Retail Pharmacy in Bayonne, NJ
• Providers in Bayonne, 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 28, 2022; 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.