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General NPI Number Information
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NPI Number | 1740226836
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Entity Type | Organization
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Legal Business Name | THE ESTAUGH
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 1 MEDFORD LEAS
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City | MEDFORD
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State | NJ
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Zip | 08055-2254
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Country | US
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Telephone | 609-654-3269
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Fax | 609-257-0827
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Provider Business Mailing Address
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Address Line | 1 MEDFORD LEAS
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City | MEDFORD
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State | NJ
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Zip | 08055-2254
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Country | US
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Telephone | 609-654-3269
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Fax | 609-257-0827
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Authorized Official
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Title or Position | PHCY DIR
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Name | FRANK SIMMONS
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Credential | PHARM D
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Telephone | 609-654-3391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0003X
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Taxonomy Name | Managed Care Organization Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00192000
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License Number State | NJ
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