MEDICARE: NEW BRUNSWICK PHARMACY LLC

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	28RS00693200	NJ

General Provider Information

NPI Number	:	1174759187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BRUNSWICK PHARMACY LLC

Provider Business Mailing Address
First Line	:	159 FRENCH ST
Second Line	:
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-2341
Country	:	US
Telephone Number	:	732-418-1100
Fax Number	:	732-418-1109

Provider Business Practice Location Address
First Line	:	159 FRENCH ST
Second Line	:
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-2341
Country	:	US
Telephone Number	:	732-418-1100
Fax Number	:	732-418-1109

Authorized Official
Title or Position	:	PHARMACIST MANAGER
Name	:	MRS. TEJASVI PATEL
Credential	:	RPH
Telephone Number	:	732-418-1100

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	05/13/2013

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