Provider Demographics
NPI:1821421769
Name:MEDICAL ARTS PHARMACY III
Entity Type:Organization
Organization Name:MEDICAL ARTS PHARMACY III
Other - Org Name:HEALTH CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-369-6918
Mailing Address - Street 1:953 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-2733
Mailing Address - Country:US
Mailing Address - Phone:201-360-6918
Mailing Address - Fax:201-333-1149
Practice Address - Street 1:953 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-2733
Practice Address - Country:US
Practice Address - Phone:201-360-6918
Practice Address - Fax:201-333-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006567003336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0094757Medicaid
2141570OtherPK
NJ0094757Medicaid