Healthcare Provider Details

I. General information

NPI: 1124540612
Provider Name (Legal Business Name): PENNINGTON PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 PENNINGTON RD
EWING NJ
08638-1416
US

IV. Provider business mailing address

2108 PENNINGTON RD
EWING NJ
08638-1416
US

V. Phone/Fax

Practice location:
  • Phone: 609-882-2404
  • Fax: 609-882-4220
Mailing address:
  • Phone: 609-882-2404
  • Fax: 609-882-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00092000
License Number StateNJ

VIII. Authorized Official

Name: MAYUR PATEL
Title or Position: MEMBER
Credential:
Phone: 845-292-8200