Provider Demographics
NPI:1891835724
Name:F DECANDIA JR CORP
Entity Type:Organization
Organization Name:F DECANDIA JR CORP
Other - Org Name:FRANKLYNS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:DECANDIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-444-5550
Mailing Address - Street 1:204 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1545
Mailing Address - Country:US
Mailing Address - Phone:201-444-5550
Mailing Address - Fax:201-444-8180
Practice Address - Street 1:204 WARREN AVE
Practice Address - Street 2:
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1545
Practice Address - Country:US
Practice Address - Phone:201-444-5550
Practice Address - Fax:201-444-8180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NJ28RS004555003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4533801Medicaid
2051900OtherPK
NJ4533801Medicaid