Provider Demographics
NPI:1881639433
Name:FARMACIAS DEL PUEBLO II
Entity Type:Organization
Organization Name:FARMACIAS DEL PUEBLO II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R. PH. IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:973-523-2070
Mailing Address - Street 1:22 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-1721
Mailing Address - Country:US
Mailing Address - Phone:973-523-2070
Mailing Address - Fax:973-523-2590
Practice Address - Street 1:22 MARKET ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-1721
Practice Address - Country:US
Practice Address - Phone:973-523-2070
Practice Address - Fax:973-523-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9123601Medicaid
NJ4804700001Medicare NSC