Provider Demographics
NPI:1508884297
Name:NETCONG PHARMACY INC
Entity Type:Organization
Organization Name:NETCONG PHARMACY INC
Other - Org Name:LAKELAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:973-347-0068
Mailing Address - Street 1:17 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NETCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07857-1125
Mailing Address - Country:US
Mailing Address - Phone:973-347-0068
Mailing Address - Fax:973-347-6765
Practice Address - Street 1:17 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:NETCONG
Practice Address - State:NJ
Practice Address - Zip Code:07857-1125
Practice Address - Country:US
Practice Address - Phone:973-347-0068
Practice Address - Fax:973-347-6765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006423003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0047783Medicaid
2055457OtherPK
5267450001Medicare NSC