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General NPI Number Information
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NPI Number | 1851740401
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Entity Type | Organization
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Legal Business Name | FANWOOD RX CORP
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Dates
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Enumeration Date | 06/05/2016
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 45 S MARTINE AVE
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City | FANWOOD
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State | NJ
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Zip | 07023-1216
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Country | US
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Telephone | 908-680-6936
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Fax | 908-680-6937
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Provider Business Mailing Address
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Address Line | 1 TED LIGHT WAY
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City | PISCATAWAY
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State | NJ
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Zip | 08854
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Country | US
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Telephone | 848-228-9655
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Fax | 908-680-6937
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DR. MITUL P PATEL
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Credential | PHARMD
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Telephone | 908-680-6936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 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 #3
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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 #4
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00749500
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License Number State | NJ
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