Provider Demographics
NPI:1154456291
Name:QUICK CHEK CORPORATION
Entity Type:Organization
Organization Name:QUICK CHEK CORPORATION
Other - Org Name:QUICK CHEK PHARMACY DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WUNDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-534-7190
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889-0600
Mailing Address - Country:US
Mailing Address - Phone:908-534-7190
Mailing Address - Fax:908-534-7216
Practice Address - Street 1:777 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1074
Practice Address - Country:US
Practice Address - Phone:732-238-4022
Practice Address - Fax:732-238-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00389900333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3128344OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NJ4380509Medicaid
3128344OtherOTHER ID NUMBER-COMMERCIAL NUMBER