Healthcare Provider Details

I. General information

NPI: 1952553984
Provider Name (Legal Business Name): PETER A. POGANY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 PARK AVE.
PLAINFIELD NJ
07062
US

IV. Provider business mailing address

611 PARK AVE.
PLAINFIELD NJ
07062
US

V. Phone/Fax

Practice location:
  • Phone: 908-756-0008
  • Fax: 908-668-8630
Mailing address:
  • Phone: 908-756-0008
  • Fax: 908-668-8630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01395300
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier0137723
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: