Provider Demographics
NPI:1275664237
Name:IBCHU LLC
Entity Type:Organization
Organization Name:IBCHU LLC
Other - Org Name:FRIENDLY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-433-6990
Mailing Address - Street 1:360 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-3739
Mailing Address - Country:US
Mailing Address - Phone:201-433-6990
Mailing Address - Fax:201-433-6512
Practice Address - Street 1:360 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-3739
Practice Address - Country:US
Practice Address - Phone:201-433-6990
Practice Address - Fax:201-433-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS003771003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2058224OtherPK
NJ4370805Medicaid
2058224OtherPK