Provider Demographics
NPI:1235384249
Name:MIDDLETOWN FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:MIDDLETOWN FAMILY PHARMACY LLC
Other - Org Name:MIDDLETOWN FAMILY PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:STRYKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-471-9100
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:BELFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07718-0147
Mailing Address - Country:US
Mailing Address - Phone:732-471-9100
Mailing Address - Fax:732-471-9120
Practice Address - Street 1:877 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELFORD
Practice Address - State:NJ
Practice Address - Zip Code:07718-2001
Practice Address - Country:US
Practice Address - Phone:732-471-9100
Practice Address - Fax:732-471-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336S0011X
NJ28RS006868003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0192554Medicaid
2118595OtherPK
NJ6218720001Medicare NSC