Provider Demographics
NPI:1275544439
Name:NEWPORT PHARMACEUTICAL SERVICES INC
Entity Type:Organization
Organization Name:NEWPORT PHARMACEUTICAL SERVICES INC
Other - Org Name:NEWPORT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSQUERA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-963-1903
Mailing Address - Street 1:165 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1717
Mailing Address - Country:US
Mailing Address - Phone:201-963-1903
Mailing Address - Fax:201-222-6534
Practice Address - Street 1:165 ERIE ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1717
Practice Address - Country:US
Practice Address - Phone:201-963-1903
Practice Address - Fax:201-222-6534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
NJ28RS005936003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2058638OtherPK
NJ8484309Medicaid
4008110001Medicare NSC