Provider Demographics
NPI:1033214721
Name:WAYNE RX INC
Entity Type:Organization
Organization Name:WAYNE RX INC
Other - Org Name:WAYNE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-696-6667
Mailing Address - Street 1:1055 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3235
Mailing Address - Country:US
Mailing Address - Phone:973-696-6667
Mailing Address - Fax:973-872-0088
Practice Address - Street 1:1055 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3235
Practice Address - Country:US
Practice Address - Phone:973-696-6667
Practice Address - Fax:973-872-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00632700183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3145869OtherNCPDP #
NJ0019186Medicaid
NJ0019178Medicaid
NJ0019186Medicaid