Provider Demographics
NPI:1982237103
Name:HOLMDEL PHARMACY & DELI LLC
Entity Type:Organization
Organization Name:HOLMDEL PHARMACY & DELI LLC
Other - Org Name:HOLMDEL PHARMACY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKAILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-423-3300
Mailing Address - Street 1:2145 STATE ROUTE 35 UNIT 2A2
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1164
Mailing Address - Country:US
Mailing Address - Phone:732-787-6666
Mailing Address - Fax:732-787-2222
Practice Address - Street 1:2145 STATE ROUTE 35 UNIT 2A2
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1164
Practice Address - Country:US
Practice Address - Phone:732-787-6666
Practice Address - Fax:732-787-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0753211Medicaid