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General NPI Number Information
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NPI Number | 1508904640
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Entity Type | Organization
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Legal Business Name | PETER PAN PHARMACY INC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 2125 PARK AVE
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City | S PLAINFIELD
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State | NJ
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Zip | 07080-5401
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Country | US
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Telephone | 908-754-7607
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Fax | 908-754-9106
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Provider Business Mailing Address
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Address Line | 2125 PARK AVE
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City | S PLAINFIELD
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State | NJ
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Zip | 07080-5401
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Country | US
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Telephone | 908-754-7607
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Fax | 908-754-9106
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Authorized Official
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Title or Position | OWNER
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Name | DAVID KORNAS
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Credential |
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Telephone | 908-754-7607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00323500
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License Number State | NJ
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