Provider Demographics
NPI:1689986424
Name:PHARMACY PLUS & SURGICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:PHARMACY PLUS & SURGICAL SUPPLIES LLC
Other - Org Name:PHARMACY PLUS &SURGICAL SUPPLIES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:BADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-757-9664
Mailing Address - Street 1:236 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1347
Mailing Address - Country:US
Mailing Address - Phone:973-900-9275
Mailing Address - Fax:862-849-2189
Practice Address - Street 1:236 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1347
Practice Address - Country:US
Practice Address - Phone:973-900-9275
Practice Address - Fax:862-849-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NJ28RS007051003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0252298Medicaid
NJ0258440Medicaid
2125751OtherPK