Provider Demographics
NPI:1639523996
Name:A & K PHARMACY LLC
Entity Type:Organization
Organization Name:A & K PHARMACY LLC
Other - Org Name:BROADWAY CONTINENTAL DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANTIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-288-3655
Mailing Address - Street 1:150 E BOCA RATON ROAD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432
Mailing Address - Country:US
Mailing Address - Phone:561-288-3655
Mailing Address - Fax:201-854-1518
Practice Address - Street 1:7200 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047
Practice Address - Country:US
Practice Address - Phone:201-854-4800
Practice Address - Fax:201-854-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00548900333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159539OtherPK
NJ0536776Medicaid