Provider Demographics
NPI:1194764134
Name:BJS WHOLESALE CLUB INC
Entity type:Organization
Organization Name:BJS WHOLESALE CLUB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CELLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:508-651-5621
Mailing Address - Street 1:396 THRU 420 LUIS MUNOZ MARIN BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:396 THRU 420 LUIS MUNOZ MARIN BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-876-2799
Practice Address - Fax:201-876-2796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS00654400333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0093050Medicaid
3193226OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5083210034Medicare ID - Type Unspecified