Palmyra Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28RS00720700 Issued in NJ

Legal business name

PALMYRA PHARMACY LLC

Doing business as

Palmyra Pharmacy

Practice address

1 E Broad St
Palmyra, NJ 08065-1604

Phone

(856) 786-1615

Fax

(856) 786-2317

NPI assigned

Aug 27, 2012

Last updated

Aug 18, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jitenkumar P Nathani

Title

President

Phone

(856) 786-1615

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Palmyra Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

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

{
    "created_epoch": "1346025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597708800000",
    "number": "1689922569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 E BROAD ST",
            "city": "PALMYRA",
            "state": "NJ",
            "postal_code": "080651604",
            "telephone_number": "856-786-1615",
            "fax_number": "856-786-2317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 E BROAD ST",
            "city": "PALMYRA",
            "state": "NJ",
            "postal_code": "080651604",
            "telephone_number": "856-786-1615",
            "fax_number": "856-786-2317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMYRA PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-27",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A",
        "authorized_official_last_name": "NATHANI",
        "authorized_official_first_name": "JITENKUMAR",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-786-1615"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NJ",
            "license": "28RS00720700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0316229",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2136832",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palmyra Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Qmanj, Inc.

• Community/Retail Pharmacy in Palmyra, NJ
• Providers in Palmyra, 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 Aug 18, 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.

Verify at the official NPI Registry.