=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740734102
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPITAL HEALTH SYSTEM INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2016
-----------------------------------------------------
Last Update Date | 11/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 BRUNSWICK AVE
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08638-4143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-815-7824
-----------------------------------------------------
Fax | 609-815-7702
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 750 BRUNSWICK AVE ATTN. EMPLOYEE PHARMACY
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08638-4143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-815-7824
-----------------------------------------------------
Fax | 609-815-7702
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | ROSEMARY RUSSELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-537-6258
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 27RS00558800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------