Provider Demographics
NPI:1720024193
Name:HIGHLAND PARK PHARMACY CORP
Entity Type:Organization
Organization Name:HIGHLAND PARK PHARMACY CORP
Other - Org Name:SAIFF DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKTAL
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:732-545-0687
Mailing Address - Street 1:PO BOX 4274
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904
Mailing Address - Country:US
Mailing Address - Phone:732-545-0687
Mailing Address - Fax:732-545-1156
Practice Address - Street 1:325 RARITAN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2700
Practice Address - Country:US
Practice Address - Phone:732-545-0687
Practice Address - Fax:732-545-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006700003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2054134OtherPK
NJ0149519Medicaid
0186570001Medicare NSC