Provider Demographics
NPI:1932591922
Name:BUENA CARE PHARMACY INC
Entity Type:Organization
Organization Name:BUENA CARE PHARMACY INC
Other - Org Name:EZ RX PHARMACY & COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANAKI RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AJJARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-310-1562
Mailing Address - Street 1:147 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4345
Mailing Address - Country:US
Mailing Address - Phone:732-324-5666
Mailing Address - Fax:732-324-5652
Practice Address - Street 1:147 SMITH ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4345
Practice Address - Country:US
Practice Address - Phone:732-324-5666
Practice Address - Fax:732-324-5652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NJ28RS006023003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150522OtherPK
NJ049-1021Medicaid