MEDICARE: PLAINS PHARMACY OF WAYNE TWP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	28RS00668900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013048065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAINS PHARMACY OF WAYNE TWP INC

Provider Business Mailing Address
First Line	:	578 VALLEY RD
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-3526
Country	:	US
Telephone Number	:	973-694-5522
Fax Number	:	973-694-1751

Provider Business Practice Location Address
First Line	:	578 VALLEY RD
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-3526
Country	:	US
Telephone Number	:	973-694-5522
Fax Number	:	973-694-1751

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MANU KAKAR
Credential	:
Telephone Number	:	973-694-5522

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	09/27/2023

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