Provider Demographics
NPI:1851608111
Name:ATLANTICARE REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:ATLANTICARE REGIONAL MEDICAL CENTER
Other - Org Name:ATLANTICARE PHARMACY AT POMONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-280-0547
Mailing Address - Street 1:54 W JIMMIE LEEDS RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9401
Mailing Address - Country:US
Mailing Address - Phone:609-404-7444
Mailing Address - Fax:609-404-7445
Practice Address - Street 1:54 W JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9401
Practice Address - Country:US
Practice Address - Phone:609-404-7444
Practice Address - Fax:609-404-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007068003336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3197262OtherNCPDP PROVIDER IDENTIFICATION NUMBER