Active NPI
Passaic Community Pharmacy Inc
- Pharmacist
- Passaic, NJ
National Provider Identifier
1205871027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RS00592100
- Legal business name
- PASSAIC COMMUNITY PHARMACY INC
- Practice address
- 339 Passaic Street
Passaic, NJ 07055 - Phone
- (973) 471-0160
- Fax
- (973) 471-0110
- NPI assigned
- Jun 17, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sam Awad
- Title
- Officer
- Phone
- (973) 471-0160
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RS00592100 | NJ | Primary |
Addresses
Primary practice location
339 Passaic Street
Passaic, NJ 07055
Mailing address
9 Christopher Court
Matawan, NJ 07747
Phone (973) 471-0160
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 99984 | Other | NJ | AMERIROUP ID # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930080487 | NJ | DME Supplier - Pharmacy | 0547380230 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Passaic, NJ |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
339 Passaic St
Passaic, NJ 07055
Phone (973) 471-0160
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1205871027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 CHRISTOPHER COURT",
"city": "MATAWAN",
"state": "NJ",
"postal_code": "07747",
"telephone_number": "973-471-0160",
"fax_number": "973-471-0110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "339 PASSAIC STREET",
"city": "PASSAIC",
"state": "NJ",
"postal_code": "07055",
"telephone_number": "973-471-0160",
"fax_number": "973-471-0110"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PASSAIC COMMUNITY PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-17",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "AWAD",
"authorized_official_first_name": "SAM",
"authorized_official_title_or_position": "OFFICER",
"authorized_official_telephone_number": "973-471-0160"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RS00592100",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIROUP ID #",
"identifier": "99984",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Passaic, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.