Provider Demographics
NPI:1174991525
Name:SEROM PHARMACY LLC
Entity type:Organization
Organization Name:SEROM PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:201-242-1000
Mailing Address - Street 1:210 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1509
Mailing Address - Country:US
Mailing Address - Phone:201-242-1000
Mailing Address - Fax:201-242-1010
Practice Address - Street 1:210 BROAD AVE
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1509
Practice Address - Country:US
Practice Address - Phone:201-242-1000
Practice Address - Fax:201-242-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007431003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0507024Medicaid
NJ3150517OtherNCPDP
NJ7506090001Medicare NSC