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General NPI Number Information
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NPI Number | 1548249717
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Entity Type | Organization
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Legal Business Name | TERRACE APOTHECARY INC
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 169 TERRACE ST
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City | HAWORTH
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State | NJ
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Zip | 07641-1835
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Country | US
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Telephone | 201-384-7171
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Fax | 201-384-4433
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Provider Business Mailing Address
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Address Line | 169 TERRACE ST
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City | HAWORTH
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State | NJ
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Zip | 07641-1835
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Country | US
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Telephone | 201-384-7171
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Fax | 201-384-4433
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WESTLEY V WALLER III
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Credential | PHARMD
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Telephone | 201-384-7171
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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 | 28RS00478500
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License Number State | NJ
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