MEDICARE: HOMESTEAD PHARMACY

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	28RS00040700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2054421	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770676116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMESTEAD PHARMACY

Provider Business Mailing Address
First Line	:	601 BROADWAY
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-5906
Country	:	US
Telephone Number	:	732-222-5400
Fax Number	:	732-571-9688

Provider Business Practice Location Address
First Line	:	601 BROADWAY
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-5906
Country	:	US
Telephone Number	:	732-222-5400
Fax Number	:	732-571-9688

Authorized Official
Title or Position	:	MANAGER
Name	:	PHILLIP DONATO
Credential	:
Telephone Number	:	732-222-5400

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	02/26/2015

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Directions to “HOMESTEAD PHARMACY ” Practice Location

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