Provider Demographics
NPI:1659596468
Name:DAYTON PARK DRUG INC
Entity Type:Organization
Organization Name:DAYTON PARK DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ASGHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-329-2626
Mailing Address - Street 1:365 GEORGES RD STE 5
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1639
Mailing Address - Country:US
Mailing Address - Phone:732-329-2626
Mailing Address - Fax:732-329-2215
Practice Address - Street 1:365 GEORGES RD STE 5
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1639
Practice Address - Country:US
Practice Address - Phone:732-329-2626
Practice Address - Fax:732-329-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS006521003336C0003X
NJ28RS006521003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0092240Medicaid
NJ0092240Medicaid