Healthcare Provider Details

I. General information

NPI: 1851204804
Provider Name (Legal Business Name): MEDFORD PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
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: 601-818-6508
  • Fax: 609-654-6884
Mailing address:
  • Phone: 609-654-6884
  • Fax: 609-654-6887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: PRIYA PATEL
Title or Position: OWNER/PHARMACIST
Credential: PHARMD.,RPH
Phone: 601-818-6508