Provider Demographics
NPI:1326212291
Name:DENDRITE PHARMACY DEPARTMENT
Entity Type:Organization
Organization Name:DENDRITE PHARMACY DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMENETZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-646-7564
Mailing Address - Street 1:25 MADISON RD
Mailing Address - Street 2:STE 1
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-1003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 MADISON RD
Practice Address - Street 2:STE 1
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1003
Practice Address - Country:US
Practice Address - Phone:800-572-3836
Practice Address - Fax:973-646-7678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006294003336M0002X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3192159OtherOTHER ID NUMBER