Healthcare Provider Details

I. General information

NPI: 1902847619
Provider Name (Legal Business Name): RIDGEMONT DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 KINDERKAMACK RD
PARK RIDGE NJ
07656-1335
US

IV. Provider business mailing address

197 KINDERKAMACK RD
PARK RIDGE NJ
07656-1335
US

V. Phone/Fax

Practice location:
  • Phone: 201-391-3232
  • Fax: 201-930-9672
Mailing address:
  • Phone: 201-391-3232
  • Fax: 201-930-9672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5743
License Number StateNJ

VIII. Authorized Official

Name: MR. ARTHUR SCOT BARTHOLD
Title or Position: OWNER/PRESIDENT
Credential: R.PH.
Phone: 201-391-3232