Healthcare Provider Details

I. General information

NPI: 1871812420
Provider Name (Legal Business Name): MEDCO HEALTH SOLUTIONS OF WILLINGBORO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MILLENIUM DR SUITE 101
WILLINGBORO NJ
08046-1000
US

IV. Provider business mailing address

1 MILLENIUM DR SUITE 101
WILLINGBORO NJ
08046-1000
US

V. Phone/Fax

Practice location:
  • Phone: 877-807-0947
  • Fax: 609-880-2221
Mailing address:
  • Phone: 877-807-0947
  • Fax: 609-880-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00701500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BARRY CESANEK
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 609-880-2307