Provider Demographics
NPI:1942521448
Name:SEASIDE PHARMACY
Entity type:Organization
Organization Name:SEASIDE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KANAKIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-250-6600
Mailing Address - Street 1:410 SOUTH EAST CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SEASIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08752
Mailing Address - Country:US
Mailing Address - Phone:732-250-6600
Mailing Address - Fax:732-250-6601
Practice Address - Street 1:410 SOUTH EAST CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SEASIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:08752
Practice Address - Country:US
Practice Address - Phone:732-250-6600
Practice Address - Fax:732-250-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00704400333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00704400OtherNJ BOARD OF PHARMACY