MEDICARE: BRIDGETON RX 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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1467311936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGETON RX INC

Provider Business Mailing Address
First Line	:	14 N PEARL ST STE 101
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-1902
Country	:	US
Telephone Number	:	856-319-5004
Fax Number	:	856-391-5872

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	:	856-319-5004
Fax Number	:	856-391-5872

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROSS WAGNER
Credential	:	PHARM.D.
Telephone Number	:	856-319-5004

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “BRIDGETON RX INC ” Practice Location

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