Provider Demographics
NPI:1972373009
Name:PETER PAN PHARMACY INC
Entity type:Organization
Organization Name:PETER PAN PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:908-754-7607
Mailing Address - Street 1:2125 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5498
Mailing Address - Country:US
Mailing Address - Phone:908-754-7607
Mailing Address - Fax:908-754-9106
Practice Address - Street 1:2125 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5498
Practice Address - Country:US
Practice Address - Phone:908-754-7607
Practice Address - Fax:908-754-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy