Provider Demographics
NPI:1275929150
Name:SCIENCE GLADIATORS LLC
Entity Type:Organization
Organization Name:SCIENCE GLADIATORS LLC
Other - Org Name:US PHARMACY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-322-9090
Mailing Address - Street 1:220 LIVINGSTON ST STE 106
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-1739
Mailing Address - Country:US
Mailing Address - Phone:201-322-9090
Mailing Address - Fax:201-767-2680
Practice Address - Street 1:220 LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-1738
Practice Address - Country:US
Practice Address - Phone:201-767-2621
Practice Address - Fax:201-297-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007393003336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151098OtherPK