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General NPI Number Information
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NPI Number | 1528474665
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Entity Type | Organization
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Legal Business Name | OLD STONE PHARMACY
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 07/24/2014
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Provider Practice Location Address
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Address Line | 28 W GRAND AVE SUITE 6
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City | MONTVALE
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State | NJ
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Zip | 07645-2100
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Country | US
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Telephone | 201-746-4555
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Fax | 201-745-4989
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Provider Business Mailing Address
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Address Line | 28 W GRAND AVE SUITE 6
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City | MONTVALE
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State | NJ
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Zip | 07645-2100
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Country | US
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Telephone | 201-746-4555
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Fax | 201-745-4989
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Authorized Official
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Title or Position | PHARMACIST
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Name | TARA FRICKE
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Credential |
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Telephone | 201-746-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 28RS00734600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00734600
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License Number State | NJ
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