Provider Demographics
NPI:1386927895
Name:PLANET HEALTH PHARMACY CORP
Entity type:Organization
Organization Name:PLANET HEALTH PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MAULIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-334-3460
Mailing Address - Street 1:127 HAWKINS PL
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1127
Mailing Address - Country:US
Mailing Address - Phone:973-334-3460
Mailing Address - Fax:973-334-2019
Practice Address - Street 1:127 HAWKINS PL
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1127
Practice Address - Country:US
Practice Address - Phone:973-334-3460
Practice Address - Fax:973-334-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS003910003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3198175OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3198175OtherNCPDP PROVIDER IDENTIFICATION NUMBER