Healthcare Provider Details

I. General information

NPI: 1912241340
Provider Name (Legal Business Name): GENERATION PHARMACY GROUP, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 FULTON STREET SUITE 9A
BOONTON NJ
07005
US

IV. Provider business mailing address

85 FULTON STREET SUITE 9A
BOONTON NJ
07005
US

V. Phone/Fax

Practice location:
  • Phone: 973-299-2500
  • Fax: 973-265-0005
Mailing address:
  • Phone: 973-299-2500
  • Fax: 973-265-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00722500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LINDA M WITZAL
Title or Position: PRESIDENT
Credential: RPH
Phone: 973-299-2500