Provider Demographics
NPI:1043332067
Name:PMP ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PMP ASSOCIATES, INC.
Other - Org Name:CRESTVIEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PIROVOLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-747-6833
Mailing Address - Street 1:525 STATE ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5037
Mailing Address - Country:US
Mailing Address - Phone:732-747-6833
Mailing Address - Fax:732-747-2651
Practice Address - Street 1:525 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5037
Practice Address - Country:US
Practice Address - Phone:732-747-6833
Practice Address - Fax:732-747-2651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS005980003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8953309Medicaid
NJ4095770001Medicare NSC