Provider Demographics
NPI:1780395319
Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC
Entity type:Organization
Organization Name:HACKENSACK MERIDIAN AMBULATORY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHENK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-836-4545
Mailing Address - Street 1:3 HOSPITAL PLZ STE 101
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3084
Mailing Address - Country:US
Mailing Address - Phone:732-360-3450
Mailing Address - Fax:732-360-3451
Practice Address - Street 1:3 HOSPITAL PLZ STE 101
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3084
Practice Address - Country:US
Practice Address - Phone:732-360-3450
Practice Address - Fax:732-360-3450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HACKENSACK MERIDIAN AMBULATORY CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00782900OtherSTATE BOARD OF PHARMACY REGISTRATION