Provider Demographics
NPI:1083092597
Name:NEW JERSEY LAN PHARMACY LLC
Entity Type:Organization
Organization Name:NEW JERSEY LAN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHUONGLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-481-0690
Mailing Address - Street 1:2201 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2654
Mailing Address - Country:US
Mailing Address - Phone:267-481-0690
Mailing Address - Fax:856-662-8100
Practice Address - Street 1:2201 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-2654
Practice Address - Country:US
Practice Address - Phone:267-481-0690
Practice Address - Fax:856-662-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy