SOUTH BROAD DRUGS INC (NPI# 1528089596) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528089596 |
| Entity Type | Organization |
| Organization Name | SOUTH BROAD DRUGS INC |
| Other Organization Name | SOUTH BROAD DRUGS |
| Practice Address |
1094 Broad St Newark NJ 07114-2004 |
| Practice Telephone | 9738243929 |
| Practice Fax Number | 9738249446 |
| Mailing Telephone | 9738243929 |
| Mailing Fax Number | 9738249446 |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2011-04-20 |
| Authorized Official Name | VINODRAI SHAH (SUPERVISING RPH) |
| Authorized Official Telephone | 9738243929 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
28RS00358500 | NJ | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP PROVIDER IDENTIFICATION NUMBER | 3126528 | 01 | |
| NJ | 4358007 | 05 |
| Other Name | Type Code |
|---|---|
| SOUTH BROAD DRUGS | Doing Business As Name - Organization |
| Street Address |
1094 BROAD ST |
| City | NEWARK |
| State | NJ |
| Zip Code | 07114-2004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003417288 | Ariane Monique Chua Dequina | Registered Nurse | 340 Airis Drive, Newark, NJ 07114 | 2020-11-04 |
| 1235746553 | Ellen Smith | Nurse Practitioner | 340 Airis Dr., Suite 203, Newark, NJ 07114 | 2020-09-30 |
| 1760097018 | Joslainez Gonzalo | Social Worker | 47 Miller Street, Newark, NJ 07114 | 2020-09-14 |
| 1497116156 | Berdine Macasero | Nurse Practitioner | Newark Liberty Airport, Terminal C, Room #136, Newark, NJ 07114 | 2016-03-09 |
| 1164813218 | Eugene F Vane Jr. | Dentist | 168 Frontage Road, Newark, NJ 07114 | 2015-02-11 |
| 1356769277 | Jewish Renaissance Medical Center, Inc. | Clinic/Center | 258-380 Verona Avenue, Newark, NJ 07114 | 2014-03-29 |
| 1871886549 | Debora Gildin | Nurse Practitioner | Continental Airline's Take-care Health Center, Newark International Airport Terminal C, Suite 136, Newark, NJ 07114 | 2011-05-27 |
| 1871890079 | Ewr Medport | Clinic/Center | 339 Brewster Rd, Ste 201, Newark, NJ 07114 | 2011-02-24 |
| 1023331337 | Jeffrey Witz | Chiropractor | Newark Liberty International Airport, Bldg 339 Ste 201, Newark, NJ 07114 | 2010-03-02 |
| 1073794244 | Amelita Escalona Canubida | Nurse Practitioner | Newark International Airport, Terminal C, Room 136, Newark, NJ 07114 | 2007-11-16 |
| Find all providers in zip 07114 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740812155 | Connie Man | Pharmacy | 6170 Thornton Ave Ste E, Newark, CA 94560-3700 | 2020-02-05 |
| 1083250773 | Newark Pharmacy LLC | Pharmacy | 635 Market St Unit 1c, Newark, NJ 07105-3618 | 2019-11-18 |
| 1891347225 | Obeng Pharmacy LLC | Pharmacy | 431-433 Elizabeth Avenue, Newark, NJ 07112 | 2019-07-16 |
| 1730677998 | Delaware Cvs Pharmacy LLC | Pharmacy | 604 Corner Ketch Rd, Newark, DE 19711-2901 | 2018-04-24 |
| 1376052670 | Obeng Pharmacy LLC | Pharmacy | 95 Broadway, Newark, NJ 07104-3875 | 2017-09-29 |
| 1366893851 | Nikkys Pharmacy LLC | Pharmacy | 342-344 Hawthorne Ave, Newark, NJ 07112-1688 | 2016-06-26 |
| 1437539103 | Newark Shoprite LLC | Pharmacy | 206 Springfield Ave, Newark, NJ 07103-2916 | 2015-06-08 |
| 1346658143 | Rite Aid | Pharmacy | 42 Ferry St, Newark, NJ 07105-2979 | 2014-07-25 |
| 1952721847 | St Peter Pharmacy | Pharmacy | 15-17 Ropes Pl, #106, Newark, NJ 07107-4803 | 2014-04-18 |
| 1649699042 | 709 Ace Pharmacy | Pharmacy | 709 Frelinghuysen Ave, Newark, NJ 07114-1304 | 2014-04-14 |
| Find all providers in NEWARK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.