Provider Demographics
NPI:1649682071
Name:VENCER CARE PHARMACY LLC
Entity type:Organization
Organization Name:VENCER CARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTH MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-469-2221
Mailing Address - Street 1:570 N BROAD ST
Mailing Address - Street 2:SUITE-L
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:570 N BROAD ST
Practice Address - Street 2:SUITE-L
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3314
Practice Address - Country:US
Practice Address - Phone:908-469-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007332003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy