Provider Demographics
NPI:1396880035
Name:A.J.'S PHARMACY INC.
Entity type:Organization
Organization Name:A.J.'S PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAKUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-945-0772
Mailing Address - Street 1:673 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1919
Mailing Address - Country:US
Mailing Address - Phone:201-945-0772
Mailing Address - Fax:
Practice Address - Street 1:673 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1919
Practice Address - Country:US
Practice Address - Phone:201-945-0772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R00615200333600000X
NJ28RS006152003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8909504Medicaid
NJ4601910001Medicare NSC