Provider Demographics
NPI:1811038896
Name:GROSSANO AND WEINERT PHARMACY INC
Entity type:Organization
Organization Name:GROSSANO AND WEINERT PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:GROSSANO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, PHARMD
Authorized Official - Phone:201-384-2820
Mailing Address - Street 1:32 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2325
Mailing Address - Country:US
Mailing Address - Phone:201-384-2820
Mailing Address - Fax:201-384-3093
Practice Address - Street 1:32 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2325
Practice Address - Country:US
Practice Address - Phone:201-384-2820
Practice Address - Fax:201-384-3093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS004794003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3106831OtherNCPDP #
NJ4269608Medicaid
3106831OtherNCPDP #