Provider Demographics
NPI:1558598904
Name:HEALTH CENTER PHARMACY INC
Entity Type:Organization
Organization Name:HEALTH CENTER PHARMACY INC
Other - Org Name:HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANDWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-861-7521
Mailing Address - Street 1:6200 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1619
Mailing Address - Country:US
Mailing Address - Phone:201-861-7521
Mailing Address - Fax:201-861-7411
Practice Address - Street 1:6200 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1619
Practice Address - Country:US
Practice Address - Phone:201-861-7521
Practice Address - Fax:201-861-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006896003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8520801Medicaid
3196121OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3930690001Medicare NSC