Provider Demographics
NPI:1962718668
Name:GOODMAN PHARMACY & SURGICAL INC
Entity type:Organization
Organization Name:GOODMAN PHARMACY & SURGICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHRMACY TECH
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIHARIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SONI
Authorized Official - Suffix:
Authorized Official - Credentials:MGR
Authorized Official - Phone:973-777-2727
Mailing Address - Street 1:296 PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5813
Mailing Address - Country:US
Mailing Address - Phone:973-777-2727
Mailing Address - Fax:973-777-2777
Practice Address - Street 1:296 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5813
Practice Address - Country:US
Practice Address - Phone:973-777-2727
Practice Address - Fax:973-777-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6487960001Medicare NSC