Provider Demographics
NPI:1043804495
Name:BALD EAGLE DRUGS INC
Entity Type:Organization
Organization Name:BALD EAGLE DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-225-0970
Mailing Address - Street 1:610 VALLEY HEALTH PLZ
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3607
Mailing Address - Country:US
Mailing Address - Phone:201-225-0970
Mailing Address - Fax:
Practice Address - Street 1:610 VALLEY HEALTH PLZ
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3607
Practice Address - Country:US
Practice Address - Phone:201-225-0970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy