Provider Demographics
NPI:1235378761
Name:TEXAS ROAD APPLEGARTH
Entity Type:Organization
Organization Name:TEXAS ROAD APPLEGARTH
Other - Org Name:TEXAS ROAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-235-9368
Mailing Address - Street 1:355 APPLEGARTH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3733
Mailing Address - Country:US
Mailing Address - Phone:609-235-9368
Mailing Address - Fax:609-235-9399
Practice Address - Street 1:355 APPLEGARTH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-3733
Practice Address - Country:US
Practice Address - Phone:609-235-9368
Practice Address - Fax:609-235-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
NJ28RS006877003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118912OtherPK
NJ0293024Medicaid
6655440001Medicare NSC