Provider Demographics
NPI:1922181874
Name:ST. PETER'S PHARMACY & DRUGS LLC
Entity Type:Organization
Organization Name:ST. PETER'S PHARMACY & DRUGS LLC
Other - Org Name:BETTER LIFE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:WAEL
Authorized Official - Middle Name:NABIL
Authorized Official - Last Name:ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-659-8492
Mailing Address - Street 1:1000 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030
Mailing Address - Country:US
Mailing Address - Phone:201-659-8492
Mailing Address - Fax:201-659-0350
Practice Address - Street 1:1000 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030
Practice Address - Country:US
Practice Address - Phone:201-659-8492
Practice Address - Fax:201-659-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006999003336C0003X
332100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0236101Medicaid
2123277OtherPK