Provider Demographics
NPI:1790790384
Name:UNION SIDE RX INC
Entity Type:Organization
Organization Name:UNION SIDE RX INC
Other - Org Name:AMERICAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARMESHWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMNAUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-333-6663
Mailing Address - Street 1:509 W SIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1515
Mailing Address - Country:US
Mailing Address - Phone:201-333-6663
Mailing Address - Fax:201-333-3613
Practice Address - Street 1:509 W SIDE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1515
Practice Address - Country:US
Practice Address - Phone:201-333-6663
Practice Address - Fax:201-333-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS00651703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055643OtherPK
NJ0078425Medicaid
5501710001Medicare NSC