Provider Demographics
NPI:1013056068
Name:SHIPPEES PHARMACY INC
Entity Type:Organization
Organization Name:SHIPPEES PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:HERINA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-835-6871
Mailing Address - Street 1:636 RINGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WANAQUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07465-2016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:636 RINGWOOD AVE
Practice Address - Street 2:
Practice Address - City:WANAQUE
Practice Address - State:NJ
Practice Address - Zip Code:07465-2016
Practice Address - Country:US
Practice Address - Phone:973-835-6871
Practice Address - Fax:973-835-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS005633003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3116515OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3116515OtherOTHER ID NUMBER
NJ7836708Medicaid
NJ7836708Medicaid