Provider Demographics
NPI:1114060829
Name:RXD PHARMACY OF NJ INC
Entity Type:Organization
Organization Name:RXD PHARMACY OF NJ INC
Other - Org Name:ELLIS DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHARIMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-577-4577
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:RXD PHARMACY OF NJ INC
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-0428
Mailing Address - Country:US
Mailing Address - Phone:856-858-9292
Mailing Address - Fax:856-858-7286
Practice Address - Street 1:617 BROADWAY AVE
Practice Address - Street 2:ELLIS DRUGS
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103
Practice Address - Country:US
Practice Address - Phone:856-964-1399
Practice Address - Fax:856-964-1239
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RXD PHARMACY OF NJ INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS033733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3118583OtherNCPDP
NJRS03373OtherSTATE LICENSE
NJ4313500Medicaid
NJBE130638OtherDEA NUMBER
NJ0392760006Medicare ID - Type Unspecified