Healthcare Provider Details

I. General information

NPI: 1588894000
Provider Name (Legal Business Name): CREATIVE PHARMACY SOLUTIONS EAST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440A RARITAN AVE
HIGHLAND PARK NJ
08904-2740
US

IV. Provider business mailing address

2535 JOHNS PL
JAMESTOWN NY
14701-9210
US

V. Phone/Fax

Practice location:
  • Phone: 732-640-0786
  • Fax: 732-640-0787
Mailing address:
  • Phone: 716-720-5121
  • Fax: 716-708-6248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00750200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RICHARD MOON
Title or Position: PRESIDENT
Credential:
Phone: 716-720-5121