Provider Demographics
NPI:1588672497
Name:JNJ PHARMA LLC
Entity Type:Organization
Organization Name:JNJ PHARMA LLC
Other - Org Name:BELLEVUE DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SMITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DASARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-577-6989
Mailing Address - Street 1:254 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1752
Mailing Address - Country:US
Mailing Address - Phone:609-561-0825
Mailing Address - Fax:609-561-9578
Practice Address - Street 1:254 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1752
Practice Address - Country:US
Practice Address - Phone:609-561-0825
Practice Address - Fax:609-561-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS000715003336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0519677Medicaid
2154690OtherPK
NJ0519677Medicaid
3105930OtherNCPOP