Provider Demographics
NPI:1093076218
Name:POMPTON LAKE PHARMACY LLC
Entity Type:Organization
Organization Name:POMPTON LAKE PHARMACY LLC
Other - Org Name:SHOPPERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SNEHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-966-5022
Mailing Address - Street 1:1 JANUSON CT
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3657
Mailing Address - Country:US
Mailing Address - Phone:201-966-5022
Mailing Address - Fax:
Practice Address - Street 1:750 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1452
Practice Address - Country:US
Practice Address - Phone:973-835-9900
Practice Address - Fax:973-835-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007191003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135417OtherPK
NJ6696970001Medicare NSC