Healthcare Provider Details

I. General information

NPI: 1508953704
Provider Name (Legal Business Name): WOODBINE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 DEHIRSCH AVE
WOODBINE NJ
08270-2338
US

IV. Provider business mailing address

PO BOX 438
WOODBINE NJ
08270-0438
US

V. Phone/Fax

Practice location:
  • Phone: 609-861-5124
  • Fax: 609-861-1248
Mailing address:
  • Phone: 609-861-1248
  • Fax: 609-861-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number28RS00276600
License Number StateNJ

VIII. Authorized Official

Name: CHARLES NEFF
Title or Position: PRESIDENT
Credential: RPH
Phone: 609-861-5124