Provider Demographics
NPI:1598836512
Name:I A CORP
Entity Type:Organization
Organization Name:I A CORP
Other - Org Name:THE FORER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-921-7287
Mailing Address - Street 1:160 WITHERSPOON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-3223
Mailing Address - Country:US
Mailing Address - Phone:609-921-7287
Mailing Address - Fax:609-497-3912
Practice Address - Street 1:160 WITHERSPOON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-3223
Practice Address - Country:US
Practice Address - Phone:609-921-7287
Practice Address - Fax:609-497-3912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NJ28RS003439003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4349008Medicaid
3114458OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0761010001Medicare NSC