Provider Demographics
NPI:1962565838
Name:MIDTOWN PHARMACEUTICAL SERVICES INC.
Entity type:Organization
Organization Name:MIDTOWN PHARMACEUTICAL SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:DATWANI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-991-3454
Mailing Address - Street 1:581 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2737
Mailing Address - Country:US
Mailing Address - Phone:201-991-3454
Mailing Address - Fax:201-991-1319
Practice Address - Street 1:581 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2737
Practice Address - Country:US
Practice Address - Phone:201-991-3454
Practice Address - Fax:201-991-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS004528003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4425405Medicaid
NJ0897470001Medicare ID - Type Unspecified