Provider Demographics
NPI:1073165403
Name:QUICK MART PHARMACY & CONVENIENCE LLC
Entity Type:Organization
Organization Name:QUICK MART PHARMACY & CONVENIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-LLC
Authorized Official - Prefix:
Authorized Official - First Name:ALOK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:732-745-7222
Mailing Address - Street 1:100 RYDERS LN STE 5
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08850-1263
Mailing Address - Country:US
Mailing Address - Phone:732-745-7222
Mailing Address - Fax:732-545-4402
Practice Address - Street 1:100 RYDERS LN STE 5
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08850-1263
Practice Address - Country:US
Practice Address - Phone:732-745-7222
Practice Address - Fax:732-545-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0437395Medicaid