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General NPI Number Information
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NPI Number | 1427327568
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Entity Type | Organization
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Legal Business Name | GHLT LLC
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 02/08/2013
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Provider Practice Location Address
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Address Line | 1195 ROUTE 70
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5946
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Country | US
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Telephone | 732-994-7888
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Fax |
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Provider Business Mailing Address
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Address Line | 1195 ROUTE 70
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5946
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Country | US
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Telephone | 732-994-7888
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MR. CHARLES TRUONG
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Credential | R.PH.
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Telephone | 732-994-7888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00717000
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License Number State | NJ
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