Provider Demographics
NPI:1912274929
Name:UNICARE PHARMACY
Entity Type:Organization
Organization Name:UNICARE PHARMACY
Other - Org Name:UNICARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHARMACY MANAGER, AO
Authorized Official - Prefix:
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAVIYA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:973-751-0307
Mailing Address - Street 1:122 WASHINGTON AVE
Mailing Address - Street 2:G-FLOOR
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2926
Mailing Address - Country:US
Mailing Address - Phone:973-751-0307
Mailing Address - Fax:973-751-0702
Practice Address - Street 1:122 WASHINGTON AVE
Practice Address - Street 2:G-FLOOR
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2926
Practice Address - Country:US
Practice Address - Phone:973-751-0307
Practice Address - Fax:973-751-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007166003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132776OtherPK
NJ0294373Medicaid
6669240001Medicare NSC