Provider Demographics
NPI:1194906172
Name:PHARMCARE USA OF EDISON, INC.
Entity type:Organization
Organization Name:PHARMCARE USA OF EDISON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARNEY
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:866-403-2003
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:HYDRO
Mailing Address - State:OK
Mailing Address - Zip Code:73048-0012
Mailing Address - Country:US
Mailing Address - Phone:866-219-3619
Mailing Address - Fax:855-937-0782
Practice Address - Street 1:450 RARITAN CENTER PKWY STE C
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3944
Practice Address - Country:US
Practice Address - Phone:732-346-1333
Practice Address - Fax:855-937-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006758003336H0001X, 3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6112460001Medicare NSC