Provider Demographics
NPI:1801953963
Name:PLAINFIELD DRUGS CORP
Entity type:Organization
Organization Name:PLAINFIELD DRUGS CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KAUSTUBH
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHUKLA
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:908-756-2599
Mailing Address - Street 1:603 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-2006
Mailing Address - Country:US
Mailing Address - Phone:908-756-2599
Mailing Address - Fax:908-756-2594
Practice Address - Street 1:603 W 4TH ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-2006
Practice Address - Country:US
Practice Address - Phone:908-756-2599
Practice Address - Fax:908-756-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00521200333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6703607Medicaid
NJ6703607Medicaid