Provider Demographics
NPI:1609145952
Name:JR FRIENDLY PHARMACY LLC
Entity Type:Organization
Organization Name:JR FRIENDLY PHARMACY LLC
Other - Org Name:FRIENDLY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:POTTACKAL
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-985-8432
Mailing Address - Street 1:570 RARITAN RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2446
Mailing Address - Country:US
Mailing Address - Phone:908-587-0020
Mailing Address - Fax:908-587-1002
Practice Address - Street 1:570 RARITAN RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2446
Practice Address - Country:US
Practice Address - Phone:908-587-0020
Practice Address - Fax:908-587-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007178003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3198391OtherNCPDP (NABP)
NJ0432881Medicaid
2133106OtherPK