Provider Demographics
NPI:1093575458
Name:RANCH HEALTH EDISON LLC
Entity Type:Organization
Organization Name:RANCH HEALTH EDISON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:908-858-3672
Mailing Address - Street 1:561 US HIGHWAY 1 UNIT 101
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4400
Mailing Address - Country:US
Mailing Address - Phone:908-858-3672
Mailing Address - Fax:
Practice Address - Street 1:561 US HIGHWAY 1 UNIT 101
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4400
Practice Address - Country:US
Practice Address - Phone:908-858-3672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy