Provider Demographics
NPI:1396842225
Name:WERBAK INC
Entity Type:Organization
Organization Name:WERBAK INC
Other - Org Name:POMPTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STAHLBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-839-4200
Mailing Address - Street 1:558 NEWARK POMPTON TPKE
Mailing Address - Street 2:BOX 408
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1719
Mailing Address - Country:US
Mailing Address - Phone:973-839-4200
Mailing Address - Fax:973-839-7530
Practice Address - Street 1:558 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1719
Practice Address - Country:US
Practice Address - Phone:973-839-4200
Practice Address - Fax:973-839-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006096003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055045OtherPK
NJ8786801Medicaid
NJ8786810Medicaid
4415380001Medicare NSC