Provider Demographics
NPI:1558385138
Name:OHM PHARMACY, LLC
Entity Type:Organization
Organization Name:OHM PHARMACY, LLC
Other - Org Name:GERARD'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLOUGHBY
Authorized Official - Middle Name:
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-863-4882
Mailing Address - Street 1:5001 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5600
Mailing Address - Country:US
Mailing Address - Phone:201-863-4882
Mailing Address - Fax:201-863-6476
Practice Address - Street 1:5001 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5600
Practice Address - Country:US
Practice Address - Phone:201-863-4882
Practice Address - Fax:201-863-6476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS005773003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3122431OtherNCPDP
NJ28RS00577300OtherBOP