Provider Demographics
NPI:1528102563
Name:QUEEN LOVE'S PHARMACY INC.
Entity type:Organization
Organization Name:QUEEN LOVE'S PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:IFEMMUTA
Authorized Official - Middle Name:CHINWE
Authorized Official - Last Name:ADIRIKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-614-8282
Mailing Address - Street 1:934 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-8623
Mailing Address - Country:US
Mailing Address - Phone:973-614-8282
Mailing Address - Fax:973-614-8848
Practice Address - Street 1:934 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-8623
Practice Address - Country:US
Practice Address - Phone:973-614-8282
Practice Address - Fax:973-614-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00616100333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8935700Medicaid