Healthcare Provider Details

I. General information

NPI: 1245951698
Provider Name (Legal Business Name): IRON BRIDGE APOTHECARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 IRON BRIDGE RD STE 1
FREEHOLD NJ
07728-5300
US

IV. Provider business mailing address

515 IRON BRIDGE RD STE 1
FREEHOLD NJ
07728-5300
US

V. Phone/Fax

Practice location:
  • Phone: 732-252-6455
  • Fax: 848-444-9497
Mailing address:
  • Phone: 732-252-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MITESH PATEL
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD.
Phone: 732-252-6455