Provider Demographics
NPI:1407604143
Name:PKS COMPOUNDING
Entity type:Organization
Organization Name:PKS COMPOUNDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GONCALVES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:732-317-4668
Mailing Address - Street 1:1903 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3212
Mailing Address - Country:US
Mailing Address - Phone:732-317-4668
Mailing Address - Fax:
Practice Address - Street 1:1903 ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3212
Practice Address - Country:US
Practice Address - Phone:732-317-4668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy