Provider Demographics
NPI:1649212424
Name:GDN PHARMACY, LLC
Entity Type:Organization
Organization Name:GDN PHARMACY, LLC
Other - Org Name:JAYS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGRINI
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMCY
Authorized Official - Phone:201-870-9453
Mailing Address - Street 1:223 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2129
Mailing Address - Country:US
Mailing Address - Phone:201-262-1800
Mailing Address - Fax:201-262-1596
Practice Address - Street 1:223 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-2129
Practice Address - Country:US
Practice Address - Phone:201-262-1800
Practice Address - Fax:201-262-1596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS004852003336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3113317OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ4247906Medicaid
0972950001Medicare NSC