Peter Pan Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28RS00323500 Issued in NJ

Legal business name

PETER PAN PHARMACY INC

Practice address

2125 Park Ave
S Plainfield, NJ 07080-5401

Phone

(908) 754-7607

Fax

(908) 754-9106

NPI assigned

Feb 1, 2007

Organization subpart

No

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

Authorized official

Name

David KornasNPI 1366194532

Title

Owner

Phone

(908) 754-7607

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• PETER PAN PHARMACY Doing business as

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Kornas, RPH

  • Pharmacist
  • South Plainfield, NJ
  • NPI 1366194532
  NPD Authorized official
• Andrew Louka, PHARM D

  • Pharmacist
  • South Plainfield, NJ
  • NPI 1588317150
  NPD (past)

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470787200000",
    "number": "1508904640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 PARK AVE",
            "city": "S PLAINFIELD",
            "state": "NJ",
            "postal_code": "070805401",
            "telephone_number": "908-754-7607",
            "fax_number": "908-754-9106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 PARK AVE",
            "city": "S PLAINFIELD",
            "state": "NJ",
            "postal_code": "070805401",
            "telephone_number": "908-754-7607",
            "fax_number": "908-754-9106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER PAN PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2016-08-10",
        "status": "A",
        "authorized_official_last_name": "KORNAS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-754-7607"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NJ",
            "license": "28RS00323500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4253906",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2056494",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PETER PAN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cole Vision Corporation
• Leslie M Del Salto de Pena
• Doris Schueler PA
• New Jersey CVS Pharmacy LLC
• Amit Persaud, MD
• Saga Home Care LLC
• Doris Ellen Schueler
• Jamie Sim
• SM Trinity Primary Care LLC

• All providers in S Plainfield, NJ
• Community/Retail Pharmacy in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.