1194700757 NPI number — DRUG FAIR GROUP, INC.

Table of content: (NPI 1194700757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194700757 NPI number — DRUG FAIR GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRUG FAIR GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DRUG FAIR OF BERKELEY HEIGHTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194700757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 COTTONTAIL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08873-1227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-748-8900
Provider Business Mailing Address Fax Number:
732-868-4172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 SPRINGFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY HEIGHTS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07922-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-665-1230
Provider Business Practice Location Address Fax Number:
908-665-9585
Provider Enumeration Date:
12/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LEVINE
Authorized Official First Name:
BARRIE
Authorized Official Middle Name:
Authorized Official Title or Position:
V.P. PHARMACY
Authorized Official Telephone Number:
732-748-8900

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5103 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6573207 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6573215 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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