Provider Demographics
NPI:1194852509
Name:SURF CITY PHARMACY INC
Entity Type:Organization
Organization Name:SURF CITY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:609-494-5800
Mailing Address - Street 1:604 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-5249
Mailing Address - Country:US
Mailing Address - Phone:609-494-5800
Mailing Address - Fax:609-494-8694
Practice Address - Street 1:604 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SURF CITY
Practice Address - State:NJ
Practice Address - Zip Code:08008-5249
Practice Address - Country:US
Practice Address - Phone:609-494-5800
Practice Address - Fax:609-494-8694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00227000333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4261305Medicaid
NJ4261305Medicaid