Provider Demographics
NPI:1659416378
Name:SEIFERTS PHARMACY LLC
Entity Type:Organization
Organization Name:SEIFERTS PHARMACY LLC
Other - Org Name:NICHOLAS A PICCA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:PICCA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-861-2333
Mailing Address - Street 1:6801 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4405
Mailing Address - Country:US
Mailing Address - Phone:201-861-2333
Mailing Address - Fax:201-861-2477
Practice Address - Street 1:6801 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-4405
Practice Address - Country:US
Practice Address - Phone:201-861-2333
Practice Address - Fax:201-861-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS000198003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2583208OtherUNISYS
NJ3101108OtherNABP
NJ4258100Medicaid
NJ0741300001Medicare ID - Type Unspecified