Provider Demographics
NPI:1417095613
Name:MAX DRUGS, INC.
Entity Type:Organization
Organization Name:MAX DRUGS, INC.
Other - Org Name:MORT JACOBS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE HOMBRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-279-4600
Mailing Address - Street 1:506 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07504-1532
Mailing Address - Country:US
Mailing Address - Phone:973-279-4600
Mailing Address - Fax:
Practice Address - Street 1:506 PARK AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07504-1532
Practice Address - Country:US
Practice Address - Phone:973-279-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006480003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0069183Medicaid
NJ5469610001Medicare NSC