Provider Demographics
NPI:1063843241
Name:ATLANTICARE REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:ATLANTICARE REGIONAL MEDICAL CENTER
Other - Org Name:ATLANTICARE COMMUNITY PHARMACY -POMONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP PHARMACY/MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-449-4336
Mailing Address - Street 1:65 W JIMMIE LEEDS RD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NJ
Mailing Address - Zip Code:08240-9102
Mailing Address - Country:US
Mailing Address - Phone:609-404-4833
Mailing Address - Fax:609-404-4834
Practice Address - Street 1:65 W JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-9102
Practice Address - Country:US
Practice Address - Phone:609-404-4833
Practice Address - Fax:609-404-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007303003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6483940003Medicare NSC