Provider Demographics
NPI:1497483200
Name:UNIVERSITY PLAZA CORP
Entity Type:Organization
Organization Name:UNIVERSITY PLAZA CORP
Other - Org Name:DRUG WORX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAULOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-343-5850
Mailing Address - Street 1:198-208 W MARKET ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103
Mailing Address - Country:US
Mailing Address - Phone:973-343-5850
Mailing Address - Fax:973-343-5851
Practice Address - Street 1:198-208 W MARKET ST
Practice Address - Street 2:SUITE 216
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-343-5850
Practice Address - Fax:973-343-5851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0886921Medicaid