Provider Demographics
NPI:1598390833
Name:NJ PHARMALOGICS LLC
Entity Type:Organization
Organization Name:NJ PHARMALOGICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:201-500-9366
Mailing Address - Street 1:3510 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4775
Mailing Address - Country:US
Mailing Address - Phone:201-500-9366
Mailing Address - Fax:201-500-9367
Practice Address - Street 1:3510 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4775
Practice Address - Country:US
Practice Address - Phone:201-500-9366
Practice Address - Fax:201-500-9367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0681628Medicaid