Provider Demographics
NPI:1700255791
Name:PROVISION PHARMACY INC
Entity Type:Organization
Organization Name:PROVISION PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HEMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKADIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-333-0226
Mailing Address - Street 1:30 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2210
Mailing Address - Country:US
Mailing Address - Phone:732-333-0226
Mailing Address - Fax:732-333-0291
Practice Address - Street 1:30 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2210
Practice Address - Country:US
Practice Address - Phone:732-333-0226
Practice Address - Fax:732-333-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007440003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy