200 Chestnut St LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28RS00660900 Issued in NJ

Legal business name

200 CHESTNUT ST LLC

Doing business as

Roselle Park Rita Pharmacy

Practice address

200 Chestnut St
Roselle Park, NJ 07204-2263

Phone

(908) 245-1396

Fax

(908) 245-1616

NPI assigned

Jun 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sanjay Shah, RPH

Title

Pharmacist in Charge

Phone

(908) 245-1396

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• ROSELLE PARK RITA PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487203200000",
    "number": "1508801713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CHESTNUT ST",
            "city": "ROSELLE PARK",
            "state": "NJ",
            "postal_code": "072042263",
            "telephone_number": "908-245-1396",
            "fax_number": "908-245-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CHESTNUT ST",
            "city": "ROSELLE PARK",
            "state": "NJ",
            "postal_code": "072042263",
            "telephone_number": "908-245-1396",
            "fax_number": "908-245-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "200 CHESTNUT ST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2017-02-16",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "SANJAY",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "908-245-1396",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NJ",
            "license": "28RS00660900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0102831",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2054615",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ROSELLE PARK RITA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Adoreli Afuang Abano, APN
• Lashawn Meri Adams
• Raven Adkins, BCBA
• Adina N Alexescu, M.D.
• Allies, Inc.

• Community/Retail Pharmacy in Roselle Park, NJ
• Providers in Roselle Park, NJ by specialty
• Community/Retail Pharmacy in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.