Provider Demographics
NPI: | 1619041258 |
---|---|
Name: | FOOD CIRCUS SUPERMARKETS INC. |
Entity type: | Organization |
Organization Name: | FOOD CIRCUS SUPERMARKETS INC. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR OF PHARMACY |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | PAUL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SCHNEIDER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RP |
Authorized Official - Phone: | 731-758-0008 |
Mailing Address - Street 1: | 1560 STATE ROUTE 35 |
Mailing Address - Street 2: | |
Mailing Address - City: | OCEAN |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07712-3521 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 732-493-1212 |
Mailing Address - Fax: | 732-695-1419 |
Practice Address - Street 1: | 1560 STATE ROUTE 35 |
Practice Address - Street 2: | |
Practice Address - City: | OCEAN |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07712-3521 |
Practice Address - Country: | US |
Practice Address - Phone: | 732-493-1212 |
Practice Address - Fax: | 732-695-1419 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-17 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | R11066 | 3336C0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |