Healthcare Provider Details

I. General information

NPI: 1003029083
Provider Name (Legal Business Name): WAINGER'S DRUG STORE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 SOUTH BROAD ST.
ELIZABETH NJ
07202-2601
US

IV. Provider business mailing address

605 SOUTH BROAD ST.
ELIZABETH NJ
07202-2601
US

V. Phone/Fax

Practice location:
  • Phone: 908-354-2416
  • Fax: 908-352-0300
Mailing address:
  • Phone: 908-354-2416
  • Fax: 908-352-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. MYRON JAMES WAINGER
Title or Position: OWNER
Credential: RETIRED RPH
Phone: 908-354-2416