Organization
SOUTH BROAD DRUGS INC
Active
Other names
SOUTH BROAD DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
VINODRAI SHAH RPH (SUPERVISING RPH)
(973) 824-3929
Entity
Organization
Contact information
Practice address
1094 BROAD ST, NEWARK, NJ 07114-2004
(973) 824-3929
(973) 824-9446
Mailing address
1094 BROAD ST, NEWARK, NJ 07114-2004
(973) 824-3929
(973) 824-9446
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
28RS00358500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3126528
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
4358007
—
NJ
Enumeration date
07/22/2006
Last updated
04/20/2011
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