Provider Demographics
NPI:1952453631
Name:DEVINE'S PHARMACY, INC.
Entity Type:Organization
Organization Name:DEVINE'S PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABAID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEEMA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:347-543-3955
Mailing Address - Street 1:1949 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2036
Mailing Address - Country:US
Mailing Address - Phone:732-549-7117
Mailing Address - Fax:732-549-7080
Practice Address - Street 1:1949 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2036
Practice Address - Country:US
Practice Address - Phone:732-549-7117
Practice Address - Fax:732-549-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS004261003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4315901Medicaid
NJ3108493OtherNCPDP
NJ4315901Medicaid