Provider Demographics
NPI:1497853832
Name:EMERSON PHARMACY INC
Entity Type:Organization
Organization Name:EMERSON PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:D'ALESSANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-262-4999
Mailing Address - Street 1:4 EMERSON PLAZA WEST
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1826
Mailing Address - Country:US
Mailing Address - Phone:201-262-4999
Mailing Address - Fax:201-262-3870
Practice Address - Street 1:4 EMERSON PLAZA WEST
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1826
Practice Address - Country:US
Practice Address - Phone:201-262-4999
Practice Address - Fax:201-262-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5220183500000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1087620001Medicare NSC