Provider Demographics
NPI:1780717892
Name:TRIAD THERAPEUTICS INC
Entity type:Organization
Organization Name:TRIAD THERAPEUTICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-244-0044
Mailing Address - Street 1:333A ROUTE 46 W
Mailing Address - Street 2:STE 130
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2415
Mailing Address - Country:US
Mailing Address - Phone:973-244-0044
Mailing Address - Fax:973-244-0202
Practice Address - Street 1:333A ROUTE 46 W
Practice Address - Street 2:STE 130
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2415
Practice Address - Country:US
Practice Address - Phone:973-244-0044
Practice Address - Fax:973-244-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336S0011X
NJ28RS006710003336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3194521OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ0139076Medicaid
NJ01570235Medicaid
5966730001Medicare NSC