Healthcare Provider Details

I. General information

NPI: 1396720801
Provider Name (Legal Business Name): MENDHAM APOTHECARY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 E MAIN ST
MENDHAM NJ
07945-1832
US

IV. Provider business mailing address

88 E MAIN ST
MENDHAM NJ
07945-1832
US

V. Phone/Fax

Practice location:
  • Phone: 973-543-4400
  • Fax: 973-543-5451
Mailing address:
  • Phone: 973-543-4400
  • Fax: 973-543-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number4259
License Number StateNJ

VIII. Authorized Official

Name: MR. LARRY M KESSLER
Title or Position: PRESIDENT
Credential: RPH
Phone: 973-543-4400