Provider Demographics
NPI:1093878068
Name:MADISON RX, INC
Entity Type:Organization
Organization Name:MADISON RX, INC
Other - Org Name:BOTTLE HILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NARENDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:VUTLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-377-0009
Mailing Address - Street 1:42 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940
Mailing Address - Country:US
Mailing Address - Phone:973-377-0009
Mailing Address - Fax:973-301-0300
Practice Address - Street 1:42 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1895
Practice Address - Country:US
Practice Address - Phone:973-377-0009
Practice Address - Fax:973-301-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006865003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7727615OtherMEDICAID DME
NJ7727607Medicaid
NJ7727607Medicaid