Provider Demographics
NPI:1033638614
Name:WORTHKAP INC
Entity Type:Organization
Organization Name:WORTHKAP INC
Other - Org Name:PANTHER VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:ANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:908-852-8818
Mailing Address - Street 1:RT 517 VILLAGE SQUARE MALL
Mailing Address - Street 2:
Mailing Address - City:ALLAMUCHY
Mailing Address - State:NJ
Mailing Address - Zip Code:07852
Mailing Address - Country:US
Mailing Address - Phone:908-852-8818
Mailing Address - Fax:908-852-8775
Practice Address - Street 1:RT 517 VILLAGE SQUARE MALL
Practice Address - Street 2:
Practice Address - City:ALLAMUCHY
Practice Address - State:NJ
Practice Address - Zip Code:07852
Practice Address - Country:US
Practice Address - Phone:908-852-8818
Practice Address - Fax:908-852-8775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WORTHKAP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00610800332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8807418Medicaid