1689815508 NPI number — EASY PHARMACY AT SBB LLC

Table of content: (NPI 1689815508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689815508 NPI number — EASY PHARMACY AT SBB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASY PHARMACY AT SBB LLC
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:
EASY PHARMACY & SURGICALS
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:
1689815508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BOUND BROOK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08880-1466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-667-7007
Provider Business Mailing Address Fax Number:
732-667-7017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BOUND BROOK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08880-1466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-667-7007
Provider Business Practice Location Address Fax Number:
732-667-7017
Provider Enumeration Date:
03/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PARVATRAO
Authorized Official First Name:
KIRAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRES & CEO
Authorized Official Telephone Number:
732-667-7007

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  TBD , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: TBD , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: TBD , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X , with the licence number: TBD , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0217395 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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