Provider Demographics
NPI:1023173549
Name:PLH PHARMACO
Entity type:Organization
Organization Name:PLH PHARMACO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:LUCIO
Authorized Official - Last Name:MAZON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-864-1809
Mailing Address - Street 1:149 48TH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-6428
Mailing Address - Country:US
Mailing Address - Phone:201-864-1809
Mailing Address - Fax:201-864-4077
Practice Address - Street 1:149 48TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6428
Practice Address - Country:US
Practice Address - Phone:201-864-1809
Practice Address - Fax:201-864-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS00573600333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7919603Medicaid
NJ1282630001Medicare ID - Type Unspecified