Provider Demographics
NPI:1184787707
Name:FAITHFUL PHARMACY INC
Entity type:Organization
Organization Name:FAITHFUL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JINYIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-985-3896
Mailing Address - Street 1:511 OLD POST RD STE 6
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4684
Mailing Address - Country:US
Mailing Address - Phone:732-287-3999
Mailing Address - Fax:732-287-3996
Practice Address - Street 1:511 OLD POST RD STE 6
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4684
Practice Address - Country:US
Practice Address - Phone:732-287-3999
Practice Address - Fax:732-287-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS005392003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7155805Medicaid
2053754OtherPK
1324570051Medicare NSC