MEDICARE: PATERSON DRUG 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	333600000X	Pharmacy	28RS00659700	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	:	1639212533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATERSON DRUG INC

Provider Business Mailing Address
First Line	:	430 MADISON AVE
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07524-2728
Country	:	US
Telephone Number	:	973-278-5808
Fax Number	:	973-278-3547

Provider Business Practice Location Address
First Line	:	430 MADISON AVE
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07524-2728
Country	:	US
Telephone Number	:	973-278-5808
Fax Number	:	973-278-3547

Authorized Official
Title or Position	:	PRESIDENT, PHARMACIST
Name	:	MR. CHETAN GANDHI
Credential	:	RPH
Telephone Number	:	973-278-5808

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	06/18/2008

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Directions to “PATERSON DRUG INC ” Practice Location

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