Provider Demographics
NPI:1568801058
Name:EL SHADDAI PHARMACY
Entity Type:Organization
Organization Name:EL SHADDAI PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DANQUAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-537-0399
Mailing Address - Street 1:20 PEACOCK CIR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1708
Mailing Address - Country:US
Mailing Address - Phone:739-732-6203
Mailing Address - Fax:973-732-6204
Practice Address - Street 1:18 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-2502
Practice Address - Country:US
Practice Address - Phone:973-732-6203
Practice Address - Fax:973-732-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0488712Medicaid