Provider Demographics
NPI:1568455434
Name:DRUG FAIR GROUP, INC.
Entity Type:Organization
Organization Name:DRUG FAIR GROUP, INC.
Other - Org Name:DRUG FAIR OF MILLBURN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCGINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-748-8900
Mailing Address - Street 1:800 COTTONTAIL LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1227
Mailing Address - Country:US
Mailing Address - Phone:732-748-8900
Mailing Address - Fax:732-868-4172
Practice Address - Street 1:2933 VAUXHALL ROAD
Practice Address - Street 2:MILLBURN MALL
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07093
Practice Address - Country:US
Practice Address - Phone:908-964-5700
Practice Address - Fax:908-810-4638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NJ50723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6572812Medicaid
NJ6572804Medicaid
NJ6572804Medicaid