Provider Demographics
NPI:1194837377
Name:CLINTON PHARMACY, INC
Entity Type:Organization
Organization Name:CLINTON PHARMACY, INC
Other - Org Name:CLINTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAFIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:REHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-735-5316
Mailing Address - Street 1:30 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1328
Mailing Address - Country:US
Mailing Address - Phone:908-735-5316
Mailing Address - Fax:908-735-7945
Practice Address - Street 1:30 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1328
Practice Address - Country:US
Practice Address - Phone:908-735-5316
Practice Address - Fax:908-735-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00447400332B00000X, 3336C0003X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0208299Medicaid
NJ6373570001Medicare NSC