Provider Demographics
NPI:1861859092
Name:BERGEN CARE PHARMACY INC
Entity Type:Organization
Organization Name:BERGEN CARE PHARMACY INC
Other - Org Name:BERGEN CARE PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-461-4646
Mailing Address - Street 1:1622 PARKER AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6927
Mailing Address - Country:US
Mailing Address - Phone:201-461-4646
Mailing Address - Fax:201-461-4655
Practice Address - Street 1:1622 PARKER AVE STE 1A
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6927
Practice Address - Country:US
Practice Address - Phone:201-461-4646
Practice Address - Fax:201-461-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
NJ28RS00748100333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159040OtherPK
2159040OtherPK