Healthcare Provider Details

I. General information

NPI: 1790727196
Provider Name (Legal Business Name): PITMAN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 S BROADWAY
PITMAN NJ
08071-1413
US

IV. Provider business mailing address

39 S BROADWAY
PITMAN NJ
08071-1413
US

V. Phone/Fax

Practice location:
  • Phone: 856-589-2392
  • Fax: 856-589-5206
Mailing address:
  • Phone: 856-589-2392
  • Fax: 856-589-5206

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 Number28RS00642000
License Number StateNJ

VIII. Authorized Official

Name: JOHN SOBIESKI
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 856-589-2392