Healthcare Provider Details

I. General information

NPI: 1619148632
Provider Name (Legal Business Name): ONE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 STOKES RD STE 101
MEDFORD NJ
08055-3003
US

IV. Provider business mailing address

639 STOKES RD STE 101
MEDFORD NJ
08055-3003
US

V. Phone/Fax

Practice location:
  • Phone: 609-654-6884
  • Fax: 609-654-6887
Mailing address:
  • Phone: 609-654-6884
  • Fax: 609-654-6887

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 Number28RS00679100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LUDWIKOWSKI
Title or Position: OWNER
Credential: RPH
Phone: 609-654-6884