Provider Demographics
NPI:1467545897
Name:CARLBERT DRUGS INC
Entity Type:Organization
Organization Name:CARLBERT DRUGS INC
Other - Org Name:BUCKLEYS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-569-1365
Mailing Address - Street 1:35 E PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2901
Mailing Address - Country:US
Mailing Address - Phone:201-569-1345
Mailing Address - Fax:201-568-5354
Practice Address - Street 1:35 E PALISADE AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2901
Practice Address - Country:US
Practice Address - Phone:201-569-1345
Practice Address - Fax:201-568-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00419300333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4399901Medicaid
3108809OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4142140001Medicare NSC