Provider Demographics
NPI:1013048065
Name:PLAINS PHARMACY OF WAYNE TWP INC
Entity Type:Organization
Organization Name:PLAINS PHARMACY OF WAYNE TWP INC
Other - Org Name:PLAINS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANU
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-694-5522
Mailing Address - Street 1:578 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3526
Mailing Address - Country:US
Mailing Address - Phone:973-694-5522
Mailing Address - Fax:973-694-1751
Practice Address - Street 1:578 VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3526
Practice Address - Country:US
Practice Address - Phone:973-694-5522
Practice Address - Fax:973-694-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00668900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0144355Medicaid
NJ0144355Medicaid