Provider Demographics
NPI:1932331758
Name:PHARMASOOD
Entity Type:Organization
Organization Name:PHARMASOOD
Other - Org Name:HOME DRUGS STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/RRPH IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-774-3400
Mailing Address - Street 1:814 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-5910
Mailing Address - Country:US
Mailing Address - Phone:732-774-3400
Mailing Address - Fax:732-774-8698
Practice Address - Street 1:814 MAIN ST
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-5910
Practice Address - Country:US
Practice Address - Phone:732-774-3400
Practice Address - Fax:732-774-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006944003336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0283592Medicaid
2121470OtherPK
6504090001Medicare NSC