Provider Demographics
NPI:1053456707
Name:HARTFORD UNIVERSAL INC
Entity Type:Organization
Organization Name:HARTFORD UNIVERSAL INC
Other - Org Name:AMES DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMASWAMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:856-854-2022
Mailing Address - Street 1:701 COLLINGS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1725
Mailing Address - Country:US
Mailing Address - Phone:856-854-2022
Mailing Address - Fax:856-858-2898
Practice Address - Street 1:701 COLLINGS AVE
Practice Address - Street 2:
Practice Address - City:WEST COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08107-1725
Practice Address - Country:US
Practice Address - Phone:856-854-2022
Practice Address - Fax:856-858-2898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006020003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3126706OtherNABP
NJ8753318OtherDME
NJ8753300Medicaid
NJ8753318OtherDME