Provider Demographics
NPI:1730483264
Name:T&M PHARMACY INC
Entity type:Organization
Organization Name:T&M PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-441-8470
Mailing Address - Street 1:7200 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5735
Mailing Address - Country:US
Mailing Address - Phone:201-854-4800
Mailing Address - Fax:201-854-1518
Practice Address - Street 1:7200 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5735
Practice Address - Country:US
Practice Address - Phone:201-854-4800
Practice Address - Fax:201-854-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS005489003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128142OtherPK
NJ6527630001Medicare NSC