Healthcare Provider Details

I. General information

NPI: 1528299898
Provider Name (Legal Business Name): PRESCRIPTION DISPENSARY OF ORADELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 KINDERKAMACK RD STE 104
ORADELL NJ
07649-1600
US

IV. Provider business mailing address

680 KINDERKAMACK RD SUITE104
ORADELL NJ
07649-1600
US

V. Phone/Fax

Practice location:
  • Phone: 201-322-6360
  • Fax:
Mailing address:
  • Phone: 201-322-6360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00694900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3196323
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER

VIII. Authorized Official

Name: BILL HAYES
Title or Position: VICE-PRESIDENT
Credential:
Phone: 201-322-6360