Provider Demographics
NPI:1144231663
Name:HASIARD MEO ENTERPRISE INC
Entity Type:Organization
Organization Name:HASIARD MEO ENTERPRISE INC
Other - Org Name:SPRINGFIELD AVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANTONIA
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-373-5846
Mailing Address - Street 1:658 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-1011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:658 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-1011
Practice Address - Country:US
Practice Address - Phone:973-373-5846
Practice Address - Fax:973-373-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ029443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4325807Medicaid
3122556OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3122556OtherOTHER ID NUMBER