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General NPI Number Information
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NPI Number | 1871812420
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Entity Type | Organization
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Legal Business Name | MEDCO HEALTH SOLUTIONS OF WILLINGBORO, LLC
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 1 MILLENIUM DR SUITE 101
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City | WILLINGBORO
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State | NJ
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Zip | 08046-1000
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Country | US
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Telephone | 877-807-0947
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Fax | 609-880-2221
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Provider Business Mailing Address
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Address Line | 1 MILLENIUM DR SUITE 101
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City | WILLINGBORO
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State | NJ
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Zip | 08046-1000
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Country | US
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Telephone | 877-807-0947
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Fax | 609-880-2221
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | BARRY CESANEK
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Credential |
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Telephone | 609-880-2307
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order 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 | 28RS00701500
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License Number State | NJ
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