1467776690 NPI number — MULE ROAD PHARMACY LLC

Table of content: (NPI 1467776690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467776690 NPI number — MULE ROAD PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MULE ROAD PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MULE ROAD PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467776690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 MULE ROAD
Provider Second Line Business Mailing Address:
UNIT-2, PLAZA -3
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-244-3737
Provider Business Mailing Address Fax Number:
732-244-3767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MULE RD
Provider Second Line Business Practice Location Address:
UNIT-2, PLAZA -3
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08757-6461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-244-3737
Provider Business Practice Location Address Fax Number:
732-244-3767
Provider Enumeration Date:
03/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KANUGA
Authorized Official First Name:
MALAV
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
732-244-3737

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 28RS00701600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2124433 . This is a "PK" identifier . This identifiers is of the category "OTHER".