MEDICARE: COURT HOUSE PROF PHCY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	RS00427800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3130755	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013953470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURT HOUSE PROF PHCY INC

Provider Business Mailing Address
First Line	:	315 RT 9 S STE 3
Second Line	:
City	:	CAPE MAY CT HOUSE
State	:	NJ
Zip	:	08210-1960
Country	:	US
Telephone Number	:	609-465-4661
Fax Number	:	609-465-4379

Provider Business Practice Location Address
First Line	:	315 RT 9 S STE 3
Second Line	:
City	:	CAPE MAY CT HOUSE
State	:	NJ
Zip	:	08210-1960
Country	:	US
Telephone Number	:	609-465-4661
Fax Number	:	609-465-4379

Authorized Official
Title or Position	:	OWNER
Name	:	FREDERICK MELROY
Credential	:
Telephone Number	:	609-465-4661

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	02/05/2008

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