Provider Demographics
NPI:1033396916
Name:TOMS RIVER DRUG LLC
Entity Type:Organization
Organization Name:TOMS RIVER DRUG LLC
Other - Org Name:TOMS RIVER DRUG LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-461-0763
Mailing Address - Street 1:1250 ROUTE 166
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2744
Mailing Address - Country:US
Mailing Address - Phone:732-341-1500
Mailing Address - Fax:732-341-1515
Practice Address - Street 1:1250 ROUTE 166
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2744
Practice Address - Country:US
Practice Address - Phone:732-341-1500
Practice Address - Fax:732-341-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006771003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2056238OtherPK