Provider Demographics
NPI:1356422505
Name:PAMAD, INC
Entity type:Organization
Organization Name:PAMAD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:856-262-9000
Mailing Address - Street 1:524 WILLIAMSTOWN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1824
Mailing Address - Country:US
Mailing Address - Phone:856-262-9000
Mailing Address - Fax:856-262-9054
Practice Address - Street 1:524 WILLIAMSTOWN RD
Practice Address - Street 2:SUITE C
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1824
Practice Address - Country:US
Practice Address - Phone:856-262-9000
Practice Address - Fax:856-262-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS005831003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8177309Medicaid
NJ8177317Medicaid
NJ8177317Medicaid