Provider Demographics
NPI:1003293515
Name:PARAMOUNT DRUG LLC
Entity Type:Organization
Organization Name:PARAMOUNT DRUG LLC
Other - Org Name:PARAMOUNT DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-229-2646
Mailing Address - Street 1:400 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1118
Mailing Address - Country:US
Mailing Address - Phone:856-229-2646
Mailing Address - Fax:
Practice Address - Street 1:54 E SCOTT ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:NJ
Practice Address - Zip Code:08075-3616
Practice Address - Country:US
Practice Address - Phone:856-461-0953
Practice Address - Fax:856-461-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS03457003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153099OtherPK
NJ0499731Medicaid