Healthcare Provider Details

I. General information

NPI: 1467719005
Provider Name (Legal Business Name): PCA-LTC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 FORD RD STE 220
DENVILLE NJ
07834-1300
US

IV. Provider business mailing address

66 FORD RD SUITE 220
DENVILLE NJ
07834-1379
US

V. Phone/Fax

Practice location:
  • Phone: 973-453-4666
  • Fax: 973-983-5684
Mailing address:
  • Phone: 973-453-4666
  • Fax: 973-983-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number28RS00718400
License Number StateNJ

VIII. Authorized Official

Name: GARY SEKULSKI
Title or Position: PRESIDENT
Credential:
Phone: 973-453-4666