Provider Demographics
NPI:1598847436
Name:PAN AMERICAN PHARMACY
Entity Type:Organization
Organization Name:PAN AMERICAN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:IGNACIO
Authorized Official - Last Name:ESTREMS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-861-7966
Mailing Address - Street 1:232 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2824
Mailing Address - Country:US
Mailing Address - Phone:201-861-7966
Mailing Address - Fax:201-868-7945
Practice Address - Street 1:232 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2824
Practice Address - Country:US
Practice Address - Phone:201-861-7966
Practice Address - Fax:201-868-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006278003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3116731OtherNABP NUMBER
NJ28RS00627800OtherSTATE LICENSE NUMBER
NJ4268903Medicaid
NJBP8609919OtherDEA NUMBER