Provider Demographics
NPI:1497855431
Name:GSC PHARMACY CORP
Entity Type:Organization
Organization Name:GSC PHARMACY CORP
Other - Org Name:DITTMARS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GHAZALA
Authorized Official - Middle Name:SHAHID
Authorized Official - Last Name:CHOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH REGISTERED PHARM
Authorized Official - Phone:201-339-0405
Mailing Address - Street 1:924 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3034
Mailing Address - Country:US
Mailing Address - Phone:201-339-0405
Mailing Address - Fax:201-339-6861
Practice Address - Street 1:924 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3034
Practice Address - Country:US
Practice Address - Phone:201-339-0405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4847333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4242505Medicaid
NJ4242505Medicaid
39111800001Medicare ID - Type Unspecified