Provider Demographics
NPI:1720143936
Name:PADAWAN PHARMA INC
Entity Type:Organization
Organization Name:PADAWAN PHARMA INC
Other - Org Name:TERRY DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EVGUENI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVALTCHOUK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:848-459-7648
Mailing Address - Street 1:1049 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003
Mailing Address - Country:US
Mailing Address - Phone:973-338-7300
Mailing Address - Fax:973-338-4520
Practice Address - Street 1:1049 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003
Practice Address - Country:US
Practice Address - Phone:973-338-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5843020001Medicare NSC