Healthcare Provider Details

I. General information

NPI: 1407940810
Provider Name (Legal Business Name): ATLANTIC APOTHECARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 ARNOLD AVE
POINT PLEASANT BEACH NJ
08742-2532
US

IV. Provider business mailing address

718 ARNOLD AVE
POINT PLEASANT BEACH NJ
08742-2532
US

V. Phone/Fax

Practice location:
  • Phone: 732-714-8998
  • Fax: 732-714-0825
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRS006250
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DENA FERMAN
Title or Position: THIRD PARTY PLAN COORDINATOR
Credential:
Phone: 314-993-6000