Provider Demographics
NPI:1033342175
Name:SWEDESBORO FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:SWEDESBORO FAMILY PHARMACY LLC
Other - Org Name:SWEDESBORO HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:KNAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-467-9499
Mailing Address - Street 1:1242 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1613
Mailing Address - Country:US
Mailing Address - Phone:856-467-9499
Mailing Address - Fax:856-467-9799
Practice Address - Street 1:1242 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1613
Practice Address - Country:US
Practice Address - Phone:856-467-9499
Practice Address - Fax:856-467-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007007003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3196525OtherNCPDP PROVIDER IDENTIFICATION NUMBER