Provider Demographics
NPI:1386022481
Name:HOLY NAME MEDICAL CENTER
Entity Type:Organization
Organization Name:HOLY NAME MEDICAL CENTER
Other - Org Name:PHARMACY DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PHARMACY, R.P,I.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:201-833-7136
Mailing Address - Street 1:718 TEANECK RD
Mailing Address - Street 2:PHARMACY DEPT.
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4245
Mailing Address - Country:US
Mailing Address - Phone:201-833-3055
Mailing Address - Fax:201-227-6048
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:PHARMACY DEPT.
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:201-833-3055
Practice Address - Fax:201-227-6048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS000669003336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4135407Medicaid
NJ310008Medicare PIN