MEDICARE: BRIDGETON RX INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	333600000X	Pharmacy
2	3336S0011X	Specialty Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1417693110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGETON RX INC

Provider Business Mailing Address
First Line	:	15 RAINTREE CT
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-2814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 N PEARL ST STE 101
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-1902
Country	:	US
Telephone Number	:	973-865-6577
Fax Number	:

Authorized Official
Title or Position	:	PRES
Name	:	MR. ROSS WAGNER
Credential	:
Telephone Number	:	856-319-5004

Provider Enumeration Date	:	05/06/2022
Last Update Date	:	01/10/2024

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Directions to “BRIDGETON RX INC ” Practice Location

Language	Start Address	Practice Location

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