Provider Demographics
NPI:1871606301
Name:PENLAR PHARMACY INC
Entity type:Organization
Organization Name:PENLAR PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAUSHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-667-6989
Mailing Address - Street 1:3070 BRISTOL PIKE
Mailing Address - Street 2:BLDG 2, SUITE 106
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5364
Mailing Address - Country:US
Mailing Address - Phone:917-667-6989
Mailing Address - Fax:267-523-5322
Practice Address - Street 1:160 LAWRENCEVILLE PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1470
Practice Address - Country:US
Practice Address - Phone:609-895-0444
Practice Address - Fax:609-895-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS005622003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138364OtherPK
NJ7941501Medicaid