Montclair Pharmacy RX LLC
Organization Active NPI Community/Retail Pharmacy · Upper Montclair, NJ
NPI 1104862564 · NPPES record last updated May 25, 2023
Key facts
- NPI
- 1104862564
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- MONTCLAIR PHARMACY RX LLC
- Practice address
- 732 Valley Rd
Upper Montclair, NJ 07043-1521 - Phone
- (973) 744-2113
- Fax
- (973) 744-2691
- NPI assigned
- Jun 22, 2006
- Organization subpart
- No
Authorized official
- Name
- Hema Patel
- Title
- Owner
- Phone
- (813) 304-2221
Corporate family (same tax ID) 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231014000592 | NJ | Part B Supplier - Pharmacy | 0244685048 | Practice locations: Montclair, NJ |
National Provider Directory
- Tax ID family
- Keils Pharmacy Inc
Locations
732 Valley Rd
Upper Montclair, NJ 07043
Phone (973) 733-2113
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
732 Valley Rd
Upper Montclair, NJ 07043-1521
Mailing address
732 Valley Road
Upper Montclair, NJ 07043
Phone (973) 744-2113
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2056802 | Other | PK | |
| 4248210 | Medicaid | NJ |
Other names
- Montclair Pharmacy
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All providers in Upper Montclair, NJ · Community/Retail Pharmacy in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.