Provider Demographics
NPI:1053737155
Name:BERLIN PHARMACY LLC
Entity type:Organization
Organization Name:BERLIN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:UCHENNA
Authorized Official - Last Name:ODOEMENE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:856-776-3128
Mailing Address - Street 1:360 S WHITE HORSE PIKE
Mailing Address - Street 2:UNIT C
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-1974
Mailing Address - Country:US
Mailing Address - Phone:856-336-2855
Mailing Address - Fax:856-809-6667
Practice Address - Street 1:360 S WHITE HORSE PIKE
Practice Address - Street 2:UNIT C
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-1974
Practice Address - Country:US
Practice Address - Phone:856-336-2855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007362003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0605417Medicaid