Provider Demographics
NPI:1922107036
Name:DEVINE PHARMACY LLC
Entity Type:Organization
Organization Name:DEVINE PHARMACY LLC
Other - Org Name:DEVINE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:AARTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-968-0003
Mailing Address - Street 1:DEVINE'S PHARMACY
Mailing Address - Street 2:2 S. WASHINGTON AVE.
Mailing Address - City:DUNELLEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08812
Mailing Address - Country:US
Mailing Address - Phone:732-968-0003
Mailing Address - Fax:732-968-0005
Practice Address - Street 1:DEVINE'S PHARMACY
Practice Address - Street 2:2 S. WASHINGTON AVE.
Practice Address - City:DUNELLEN
Practice Address - State:NJ
Practice Address - Zip Code:08812
Practice Address - Country:US
Practice Address - Phone:732-968-0003
Practice Address - Fax:732-968-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00451700333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4424506Medicaid
NJ0491220001Medicare NSC