Provider Demographics
NPI:1972890531
Name:SHOREVAX LLC
Entity Type:Organization
Organization Name:SHOREVAX LLC
Other - Org Name:SHORE VACCINE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-974-2929
Mailing Address - Street 1:2175 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1009
Mailing Address - Country:US
Mailing Address - Phone:732-974-2929
Mailing Address - Fax:
Practice Address - Street 1:2175 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1009
Practice Address - Country:US
Practice Address - Phone:732-974-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty