Provider Demographics
NPI:1750488441
Name:SAMUEL P RUA
Entity Type:Organization
Organization Name:SAMUEL P RUA
Other - Org Name:PARAMOUNT DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:RUA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:856-461-0953
Mailing Address - Street 1:54 E SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-3616
Mailing Address - Country:US
Mailing Address - Phone:856-461-0953
Mailing Address - Fax:856-461-6443
Practice Address - Street 1:54 E SCOTT ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:NJ
Practice Address - Zip Code:08075-3616
Practice Address - Country:US
Practice Address - Phone:856-461-0953
Practice Address - Fax:856-461-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00345700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1256560001Medicare NSC