Provider Demographics
NPI:1356026058
Name:PRIME PHARMACY
Entity type:Organization
Organization Name:PRIME PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:732-239-9031
Mailing Address - Street 1:125 WASHINGTON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-2635
Mailing Address - Country:US
Mailing Address - Phone:732-366-2656
Mailing Address - Fax:732-352-0951
Practice Address - Street 1:125 WASHINGTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-2635
Practice Address - Country:US
Practice Address - Phone:732-366-2656
Practice Address - Fax:732-352-0951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies