Provider Demographics
NPI:1538207998
Name:UNION SQUARE PHARMACY
Entity type:Organization
Organization Name:UNION SQUARE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SATYAPAL
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:PAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RPH
Authorized Official - Phone:908-353-6900
Mailing Address - Street 1:809 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2708
Mailing Address - Country:US
Mailing Address - Phone:908-353-6900
Mailing Address - Fax:908-353-5807
Practice Address - Street 1:809 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2708
Practice Address - Country:US
Practice Address - Phone:908-353-6900
Practice Address - Fax:908-353-5807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS005546003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7561407Medicaid
NJ7561407Medicaid