Healthcare Provider Details

I. General information

NPI: 1013048065
Provider Name (Legal Business Name): PLAINS PHARMACY OF WAYNE TWP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

578 VALLEY RD
WAYNE NJ
07470-3526
US

IV. Provider business mailing address

578 VALLEY RD
WAYNE NJ
07470-3526
US

V. Phone/Fax

Practice location:
  • Phone: 973-694-5522
  • Fax: 973-694-1751
Mailing address:
  • Phone: 973-694-5522
  • Fax: 973-694-1751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RS00668900
License Number StateNJ

VIII. Authorized Official

Name: MR. MANU KAKAR
Title or Position: OWNER
Credential:
Phone: 973-694-5522