Provider Demographics
NPI:1750488680
Name:CARMENS PHARMACY & MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:CARMENS PHARMACY & MEDICAL SUPPLIES INC
Other - Org Name:CARMENS PHARMACY AND MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-277-7679
Mailing Address - Street 1:418 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07524-1902
Mailing Address - Country:US
Mailing Address - Phone:973-279-0200
Mailing Address - Fax:973-279-7200
Practice Address - Street 1:418 RIVER ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07524-1902
Practice Address - Country:US
Practice Address - Phone:973-279-0200
Practice Address - Fax:973-279-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006642003336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0258121Medicaid
2056052OtherPK
NJ0254525Medicaid
NJ0254525Medicaid
NJ5755270001Medicare NSC