Provider Demographics
NPI:1619295664
Name:CLIFFSIDE PARK PHARMACY LLC
Entity Type:Organization
Organization Name:CLIFFSIDE PARK PHARMACY LLC
Other - Org Name:CLIFFSIDE PARK PHARMACY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-661-4279
Mailing Address - Street 1:337 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-2789
Mailing Address - Country:US
Mailing Address - Phone:551-313-8382
Mailing Address - Fax:201-313-9714
Practice Address - Street 1:337 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-2789
Practice Address - Country:US
Practice Address - Phone:551-313-8382
Practice Address - Fax:201-313-9714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007033003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00703300OtherPHARMACY PERMIT NUMBER
6455140001Medicare NSC