Provider Demographics
NPI:1568485829
Name:BELVIDERE PHARMACY LLC
Entity Type:Organization
Organization Name:BELVIDERE PHARMACY LLC
Other - Org Name:ZACK'S PHARMACY & GIFTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NITANG
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-475-1060
Mailing Address - Street 1:15 GREENWICH ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:NJ
Mailing Address - Zip Code:07823-1449
Mailing Address - Country:US
Mailing Address - Phone:908-475-1060
Mailing Address - Fax:908-475-1130
Practice Address - Street 1:15 GREENWICH ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823-1449
Practice Address - Country:US
Practice Address - Phone:908-475-1060
Practice Address - Fax:908-475-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006346003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0303984Medicaid
2133433OtherPK
NJ0303984Medicaid