Healthcare Provider Details

I. General information

NPI: 1013953470
Provider Name (Legal Business Name): COURT HOUSE PROF PHCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 RT 9 S STE 3
CAPE MAY CT HOUSE NJ
08210-1960
US

IV. Provider business mailing address

315 RT 9 S STE 3
CAPE MAY CT HOUSE NJ
08210-1960
US

V. Phone/Fax

Practice location:
  • Phone: 609-465-4661
  • Fax: 609-465-4379
Mailing address:
  • Phone: 609-465-4661
  • Fax: 609-465-4379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRS00427800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK MELROY
Title or Position: OWNER
Credential:
Phone: 609-465-4661