Provider Demographics
NPI:1912052861
Name:PROFESSIONAL CENTER PHARMACY INC.
Entity Type:Organization
Organization Name:PROFESSIONAL CENTER PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ RPH
Authorized Official - Prefix:
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSUBAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-691-5151
Mailing Address - Street 1:339 N ROUTE 73
Mailing Address - Street 2:WINSLOW PROFESSIONAL BUILDING
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9707
Mailing Address - Country:US
Mailing Address - Phone:856-767-6663
Mailing Address - Fax:856-767-8088
Practice Address - Street 1:339 N ROUTE 73
Practice Address - Street 2:WINSLOW PROFESSIONAL BUILDING
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9707
Practice Address - Country:US
Practice Address - Phone:856-767-6663
Practice Address - Fax:856-767-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00249400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4313909Medicaid
NJ3104356OtherNABP
NJ4313909Medicaid