Provider Demographics
NPI:1083018170
Name:FORRESTAL PHARMACY CENTER
Entity Type:Organization
Organization Name:FORRESTAL PHARMACY CENTER
Other - Org Name:MEDICAL VILLAGE PHARMACY OF PRINCETON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:609-285-5921
Mailing Address - Street 1:10 FORRESTAL ROAD SOUTH
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540
Mailing Address - Country:US
Mailing Address - Phone:609-285-5921
Mailing Address - Fax:609-285-5922
Practice Address - Street 1:10 FORRESTAL ROAD SOUTH
Practice Address - Street 2:SUITE 10
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-285-5921
Practice Address - Fax:609-285-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy