Provider Demographics
NPI:1326159666
Name:PACHO MEJIA CORPORATION
Entity Type:Organization
Organization Name:PACHO MEJIA CORPORATION
Other - Org Name:ALINA DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT,PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:PAULA
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:908-289-0443
Mailing Address - Street 1:962 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3526
Mailing Address - Country:US
Mailing Address - Phone:908-289-0443
Mailing Address - Fax:908-289-0445
Practice Address - Street 1:962 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3526
Practice Address - Country:US
Practice Address - Phone:908-289-0443
Practice Address - Fax:908-289-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS002787003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3108544OtherNABP
NJ4235908Medicaid
3108544OtherNABP