Provider Demographics
NPI:1730290974
Name:MACIAG AND TAWADROS
Entity Type:Organization
Organization Name:MACIAG AND TAWADROS
Other - Org Name:ALLSTAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RYSZARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-320-7272
Mailing Address - Street 1:105 TERHUNE AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-2805
Mailing Address - Country:US
Mailing Address - Phone:973-473-2243
Mailing Address - Fax:973-473-8387
Practice Address - Street 1:105 TERHUNE AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-2805
Practice Address - Country:US
Practice Address - Phone:973-473-2243
Practice Address - Fax:973-473-8387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336S0011X
NJ28RS003557003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135455OtherPK
NJ0311138Medicaid
6712420001Medicare NSC