Provider Demographics
NPI:1558451427
Name:15W PHARMACY INC
Entity Type:Organization
Organization Name:15W PHARMACY INC
Other - Org Name:15W PHARMACY-NEWARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-346-1333
Mailing Address - Street 1:95 NEWFIELD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3824
Mailing Address - Country:US
Mailing Address - Phone:732-346-1333
Mailing Address - Fax:734-346-9221
Practice Address - Street 1:65 JAY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3235
Practice Address - Country:US
Practice Address - Phone:732-346-1333
Practice Address - Fax:732-346-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00581200332B00000X, 333600000X, 3336L0003X
NJ28RS0005812003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8139300Medicaid
NJ8139318Medicaid
PA1007737970001Medicaid
NJ1326080001Medicare NSC