Provider Demographics
NPI:1396823803
Name:WHITE OAK DRUG
Entity Type:Organization
Organization Name:WHITE OAK DRUG
Other - Org Name:WHITE OAK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPIC
Authorized Official - Prefix:DR
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHHABRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-667-1434
Mailing Address - Street 1:88 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3374
Mailing Address - Country:US
Mailing Address - Phone:973-667-1434
Mailing Address - Fax:973-667-9755
Practice Address - Street 1:88 UNION AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3374
Practice Address - Country:US
Practice Address - Phone:973-667-1434
Practice Address - Fax:973-667-9755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS001541003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4264908Medicaid
3102655OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3102655OtherNCPDP PROVIDER IDENTIFICATION NUMBER