Provider Demographics
NPI:1659611127
Name:PGEES PHARMACY & SURGICAL
Entity Type:Organization
Organization Name:PGEES PHARMACY & SURGICAL
Other - Org Name:PGEES PHARMACY & SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BSC PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:PATIENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUSOMWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-371-1500
Mailing Address - Street 1:658 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-1011
Mailing Address - Country:US
Mailing Address - Phone:973-371-1500
Mailing Address - Fax:973-371-1502
Practice Address - Street 1:658 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-1011
Practice Address - Country:US
Practice Address - Phone:973-371-1500
Practice Address - Fax:973-371-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS07243003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3199418OtherNCPDP PROVIDER IDENTIFICATION NUMBER