Provider Demographics
NPI:1124574751
Name:GOLDEN CARES PHARMACY INC
Entity Type:Organization
Organization Name:GOLDEN CARES PHARMACY INC
Other - Org Name:GOLDEN CARES PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-343-1170
Mailing Address - Street 1:53-57 WEST FORT LEE ROAD
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603
Mailing Address - Country:US
Mailing Address - Phone:201-343-1170
Mailing Address - Fax:201-343-1190
Practice Address - Street 1:249 BROAD AVE
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1550
Practice Address - Country:US
Practice Address - Phone:201-343-1170
Practice Address - Fax:201-343-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
NJ28RS00753200333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175363OtherPK