OrganizationWillow Ave Pharmacy Llc(<Unavail>)PharmacySuppliersPractice Address212 Palisade Ave, Jersey City, NJ 07306-1116(201) 418-2830PECOS EnrollmentBased on the most recent information from CMS, provider Willow Ave Pharmacy Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1881015717Provider TypeOrganizationFull NameWillow Ave Pharmacy LlcOther Name<Unavail>SubpartNoEnumeration Date12/19/2013Last Updated6/20/2025Contact InformationPractice LocationPractice Address212 Palisade Ave, Jersey City, NJ 07306-1116Phone(201) 418-2830Fax(201) 418-2834Mailing LocationMailing Address212 Palisade Ave, Jersey City, NJ 07306-1116Phone(201) 418-2830Fax(201) 418-2834Authorized OfficialNameShah, Snehal (Member Manager)Phone(732) 763-1961Provider TaxonomiesCodeDescriptionLicenseCode3336C0003XPrimaryDescriptionPharmacySuppliersLicense28RS00730400New JerseyCode332B00000XDescriptionDurable Medical Equipment & Medical SuppliesSuppliersLicenseUnlisted IssuerCode333600000XDescriptionPharmacySuppliersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID0673145DescriptionMedicaidIssuerUnlistedNew JerseyID2143572DescriptionOtherIssuerPK