Provider Demographics
NPI:1588899538
Name:WEST MILFORD PHARMACY, INC.
Entity type:Organization
Organization Name:WEST MILFORD PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHALKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-728-1400
Mailing Address - Street 1:1495 UNION VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-1361
Mailing Address - Country:US
Mailing Address - Phone:973-728-1400
Mailing Address - Fax:973-728-0756
Practice Address - Street 1:1495 UNION VALLEY RD
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1361
Practice Address - Country:US
Practice Address - Phone:973-728-1400
Practice Address - Fax:973-728-0756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3336C0003X3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1290002Medicaid
3101223OtherNCPDP
3101223OtherNCPDP