Provider Demographics
NPI:1619296761
Name:PARKWAY PHARMACY LP
Entity Type:Organization
Organization Name:PARKWAY PHARMACY LP
Other - Org Name:PARKWAY PHARMACY LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEZNICK
Authorized Official - Suffix:
Authorized Official - Credentials:BSPHARM RPHCSP
Authorized Official - Phone:866-355-7797
Mailing Address - Street 1:3502 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3345
Mailing Address - Country:US
Mailing Address - Phone:866-355-7797
Mailing Address - Fax:888-551-6289
Practice Address - Street 1:3502 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3345
Practice Address - Country:US
Practice Address - Phone:866-355-7797
Practice Address - Fax:888-551-6289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNRX0001118333600000X
3336H0001X
NJ28RS007063003336S0011X
NC127353336S0011X
NY022-0322003336S0011X
PANP0001333336S0011X
SC171743336S0011X
RIPHN112583336S0011X
VT36.0186473336S0011X
MDPO61483336S0011X
NE10533336S0011X
IA42003336S0011X
VA02140017693336S0011X
MI53010105823336S0011X
CTPCN-00025713336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5240085 00Medicaid
NJ0245691Medicaid
NC1619296761Medicaid
2125729OtherPK
PA1026741160001Medicaid
SC7N6300Medicaid
6456940001Medicare NSC