Provider Demographics
NPI:1598862427
Name:FAIR RIDGE PHARMACY INC
Entity Type:Organization
Organization Name:FAIR RIDGE PHARMACY INC
Other - Org Name:FAIR RIDGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGRINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-943-0008
Mailing Address - Street 1:273 BERGEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-1323
Mailing Address - Country:US
Mailing Address - Phone:201-943-0008
Mailing Address - Fax:201-943-5800
Practice Address - Street 1:273 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-1323
Practice Address - Country:US
Practice Address - Phone:201-943-0008
Practice Address - Fax:201-943-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS005979003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2054313OtherPK
NJ8892504Medicaid
NJ8892504Medicaid