MEDICARE: PITMAN PHARMACY INC

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	28RS00642000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2148310	OTHER		PK

General Provider Information

NPI Number	:	1790727196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PITMAN PHARMACY INC

Provider Business Mailing Address
First Line	:	39 S BROADWAY
Second Line	:
City	:	PITMAN
State	:	NJ
Zip	:	08071-1413
Country	:	US
Telephone Number	:	856-589-2392
Fax Number	:	856-589-5206

Provider Business Practice Location Address
First Line	:	39 S BROADWAY
Second Line	:
City	:	PITMAN
State	:	NJ
Zip	:	08071-1413
Country	:	US
Telephone Number	:	856-589-2392
Fax Number	:	856-589-5206

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JOHN SOBIESKI
Credential	:
Telephone Number	:	856-589-2392

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	10/26/2016

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Directions to “PITMAN PHARMACY INC ” Practice Location

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