Provider Demographics
NPI:1932818556
Name:PENIEL PHARMACY
Entity Type:Organization
Organization Name:PENIEL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DELOVE
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:ARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-807-2763
Mailing Address - Street 1:191 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7300
Mailing Address - Country:US
Mailing Address - Phone:201-416-4377
Mailing Address - Fax:201-416-4375
Practice Address - Street 1:191 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7300
Practice Address - Country:US
Practice Address - Phone:973-807-2763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty