Provider Demographics
NPI:1831178581
Name:HEALTH CENTER PHARMACY, INC.
Entity type:Organization
Organization Name:HEALTH CENTER PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RP IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHOMBRE
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:201-861-7521
Mailing Address - Street 1:6200 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1619
Mailing Address - Country:US
Mailing Address - Phone:201-861-7521
Mailing Address - Fax:
Practice Address - Street 1:6200 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1619
Practice Address - Country:US
Practice Address - Phone:201-861-7521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00594200333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8520801Medicaid
NJ3930690001Medicare ID - Type UnspecifiedCMS MEDICARE