Organization
J&J STATE STREET PHARMACY INC
Active
Other names
J&J State Street Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES DEMICCO (PHARMACIST IN CHARGE)
(201) 981-1144
Entity
Organization
Contact information
Practice address
298 STATE ST, HACKENSACK, NJ 07601-5515
(201) 820-3360
Mailing address
298 STATE ST, HACKENSACK, NJ 07601-5515
(201) 820-3360
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
28RS00688900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0207993
—
NJ
01
—
3195674
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/02/2009
Last updated
10/27/2010
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