Provider Demographics
NPI:1023115953
Name:SAYREVILLE PHARMACY INC
Entity type:Organization
Organization Name:SAYREVILLE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-254-5858
Mailing Address - Street 1:89 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1561
Mailing Address - Country:US
Mailing Address - Phone:732-254-5858
Mailing Address - Fax:732-254-5730
Practice Address - Street 1:89 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872-1561
Practice Address - Country:US
Practice Address - Phone:732-254-5858
Practice Address - Fax:732-254-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006291003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0011321Medicaid
3145655OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4989120001Medicare NSC