Provider Demographics
NPI:1003029083
Name:WAINGER'S DRUG STORE INC.
Entity Type:Organization
Organization Name:WAINGER'S DRUG STORE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WAINGER
Authorized Official - Suffix:
Authorized Official - Credentials:RETIRED RPH
Authorized Official - Phone:908-354-2416
Mailing Address - Street 1:605 SOUTH BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-2601
Mailing Address - Country:US
Mailing Address - Phone:908-354-2416
Mailing Address - Fax:908-352-0300
Practice Address - Street 1:605 SOUTH BROAD ST.
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-2601
Practice Address - Country:US
Practice Address - Phone:908-354-2416
Practice Address - Fax:908-352-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4263502Medicaid
NJ4263502Medicaid