Provider Demographics
NPI:1174252886
Name:COMMUNITY CARE RX NJ INC
Entity Type:Organization
Organization Name:COMMUNITY CARE RX NJ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:ABDEL
Authorized Official - Last Name:MAKSOUD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:516-418-8058
Mailing Address - Street 1:225 ROUTE 46 STE 2
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-1814
Mailing Address - Country:US
Mailing Address - Phone:973-837-8044
Mailing Address - Fax:
Practice Address - Street 1:225 ROUTE 46 STE 2
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1814
Practice Address - Country:US
Practice Address - Phone:973-837-8044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250692389Medicaid