Provider Demographics
NPI:1457489718
Name:GERARD A MARRA SR INC
Entity Type:Organization
Organization Name:GERARD A MARRA SR INC
Other - Org Name:MARRAS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRA
Authorized Official - Suffix:
Authorized Official - Credentials:BS RPH
Authorized Official - Phone:201-865-3540
Mailing Address - Street 1:1285 PATERSON PLANK RD
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3228
Mailing Address - Country:US
Mailing Address - Phone:201-865-3540
Mailing Address - Fax:201-865-5537
Practice Address - Street 1:1285 PATERSON PLANK RD
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3228
Practice Address - Country:US
Practice Address - Phone:201-865-3540
Practice Address - Fax:201-865-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS000144003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4250702Medicaid
2054680OtherPK
NJ0845020001Medicare NSC