Provider Demographics
NPI:1386234995
Name:PHARMA PLUS PHARMACY LLC
Entity type:Organization
Organization Name:PHARMA PLUS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DLAVAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ATHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-370-4777
Mailing Address - Street 1:10 S NEW PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1645
Mailing Address - Country:US
Mailing Address - Phone:732-370-4777
Mailing Address - Fax:
Practice Address - Street 1:10 S NEW PROSPECT RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1645
Practice Address - Country:US
Practice Address - Phone:732-370-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHARMAPLUS PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-19
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0528455Medicaid