Provider Demographics
NPI:1154343044
Name:EAST ORANGE PHARMACY LLC
Entity type:Organization
Organization Name:EAST ORANGE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-373-9241
Mailing Address - Street 1:310 CENTRAL AVE
Mailing Address - Street 2:STE 111
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2835
Mailing Address - Country:US
Mailing Address - Phone:973-674-5777
Mailing Address - Fax:973-674-5999
Practice Address - Street 1:310 CENTRAL AVE
Practice Address - Street 2:STE 111
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2835
Practice Address - Country:US
Practice Address - Phone:973-674-5777
Practice Address - Fax:973-674-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006629003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055955OtherPK
NJ5737640001Medicare NSC