Provider Demographics
NPI:1033261292
Name:UNDERWOOD PHARMACY
Entity Type:Organization
Organization Name:UNDERWOOD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MUKUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-434-7870
Mailing Address - Street 1:546 W SIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1518
Mailing Address - Country:US
Mailing Address - Phone:201-434-7870
Mailing Address - Fax:201-434-4626
Practice Address - Street 1:546 W SIDE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1518
Practice Address - Country:US
Practice Address - Phone:201-434-7870
Practice Address - Fax:201-434-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00490700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6137300Medicaid