Provider Demographics
NPI:1073024931
Name:FIVE TOWNS PHARMACY LLC
Entity Type:Organization
Organization Name:FIVE TOWNS PHARMACY LLC
Other - Org Name:INVICTUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MEYER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:201-880-7000
Mailing Address - Street 1:60 ESSEX ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-4347
Mailing Address - Country:US
Mailing Address - Phone:201-880-7000
Mailing Address - Fax:201-880-7094
Practice Address - Street 1:60 ESSEX ST STE 105
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4347
Practice Address - Country:US
Practice Address - Phone:201-880-7000
Practice Address - Fax:201-880-7094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
NJ28RS007595003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2173100OtherPK
NY036775OtherPHARMACY LICENSE
NJ0605867Medicaid