1609057116 NPI number — DRUGFAIR OF BRIDGEWATER

Table of content: (NPI 1609057116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609057116 NPI number — DRUGFAIR OF BRIDGEWATER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRUGFAIR OF BRIDGEWATER
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:
Provider Other Organization Name Type Code:
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:
1609057116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
481 EAST UNION AVE 28
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEWATER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
481 EAST UNION AVE 28
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEWATER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-722-7001
Provider Business Practice Location Address Fax Number:
908-722-7006
Provider Enumeration Date:
11/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCGINLEY
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
G.
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: 28RS00675100 , 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: 3194812 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".




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