MEDICARE: CAMPBELLS NEPTUNE PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	28RS00654500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2055756	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568405314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMPBELLS NEPTUNE PHARMACY LLC

Provider Business Mailing Address
First Line	:	116 3RD AVE
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-6400
Country	:	US
Telephone Number	:	732-776-7575
Fax Number	:	732-776-7766

Provider Business Practice Location Address
First Line	:	116 3RD AVE
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-6400
Country	:	US
Telephone Number	:	732-776-7575
Fax Number	:	732-776-7766

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DENIS CAMPBELL
Credential	:
Telephone Number	:	732-974-2929

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	01/17/2017

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