Provider Demographics
NPI:1164845475
Name:COMMUNITY CARE RX NJ INC
Entity Type:Organization
Organization Name:COMMUNITY CARE RX NJ INC
Other - Org Name:COMMUNITY CARE RX NJ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAKSOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-837-8044
Mailing Address - Street 1:225 ROUTE 46 WEST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-1839
Mailing Address - Country:US
Mailing Address - Phone:973-837-8044
Mailing Address - Fax:973-837-8043
Practice Address - Street 1:225 ROUTE 46 WEST
Practice Address - Street 2:SUITE #4
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1839
Practice Address - Country:US
Practice Address - Phone:973-837-8044
Practice Address - Fax:973-837-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332100000X, 332B00000X, 333600000X, 3336C0003X
NJ28RS007305003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144005OtherPK
2144005OtherPK