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1023053469 NPI number — PLYMOUTH PARK PHARMACY INC

NPI Number: 1023053469
Health Care Provider/Practitioner: PLYMOUTH PARK PHARMACY INC

Information about “1023053469” NPI (PLYMOUTH PARK PHARMACY INC) exists in 1023053469 in HTML format HTML  |  1023053469 in plain Text format TXT  |  1023053469 in PDF (Portable Document Format) PDF  |  1023053469 in an XML format XML  formats.

NPI Number : 1023053469 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023053469",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PLYMOUTH PARK PHARMACY INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11 12 SADDLE RIVER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FAIR LAWN",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07410-5786",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "201-797-0006",
    "MailingAddressFaxNumber": "201-797-0007",
    "FirstLinePracticeLocationAddress": "11 12 SADDLE RIVER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAIR LAWN",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07410-5786",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "201-797-0006",
    "PracticeLocationAddressFaxNumber": "201-797-0007",
    "EnumerationDate": "06/19/2006",
    "LastUpdateDate": "10/13/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PISKADLO",
    "AuthorizedOfficialFirstName": "BRYAN",
    "AuthorizedOfficialMiddleName": "SCOTT",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "201-797-0006",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "333600000X",
          "TaxonomyName": "Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "28RS001207900",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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