Provider Demographics
NPI:1336190461
Name:DRUG FAIR GROUP, INC.
Entity Type:Organization
Organization Name:DRUG FAIR GROUP, INC.
Other - Org Name:DRUG FAIR OF PORT MONMOUTH 48
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRIE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-748-8900
Mailing Address - Street 1:800 COTTONTAIL LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1227
Mailing Address - Country:US
Mailing Address - Phone:732-748-8900
Mailing Address - Fax:732-868-4172
Practice Address - Street 1:375 HIGHWAY 36 & MAIN STREET
Practice Address - Street 2:
Practice Address - City:PORT MONMOUTH
Practice Address - State:NJ
Practice Address - Zip Code:07758
Practice Address - Country:US
Practice Address - Phone:732-787-1041
Practice Address - Fax:732-787-5632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NJ55953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0115339Medicaid
NJ7577109Medicaid
NJ0115339Medicaid