Provider Demographics
NPI:1922369800
Name:POMPTON LAKE PHARMACY LLC
Entity Type:Organization
Organization Name:POMPTON LAKE PHARMACY LLC
Other - Org Name:SHOPPERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MISS
Authorized Official - First Name:SNEHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-966-5022
Mailing Address - Street 1:750 HAMBURG TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442
Mailing Address - Country:US
Mailing Address - Phone:201-966-5022
Mailing Address - Fax:973-835-9907
Practice Address - Street 1:1 JANUSON COURT
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:201-966-5022
Practice Address - Fax:973-835-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2RS007191003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy