Provider Demographics
NPI:1467719005
Name:PCA-LTC PHARMACY
Entity Type:Organization
Organization Name:PCA-LTC PHARMACY
Other - Org Name:PCA-LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEKULSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-453-4666
Mailing Address - Street 1:66 FORD RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1379
Mailing Address - Country:US
Mailing Address - Phone:973-453-4666
Mailing Address - Fax:973-983-5684
Practice Address - Street 1:66 FORD RD STE 220
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-1300
Practice Address - Country:US
Practice Address - Phone:973-453-4666
Practice Address - Fax:973-983-5684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007184003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3198694OtherNCPDP PROVIDER IDENTIFICATION NUMBER