Provider Demographics
NPI:1245245885
Name:NEW GARDEN PHARMACY INC
Entity Type:Organization
Organization Name:NEW GARDEN PHARMACY INC
Other - Org Name:GARDEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-922-4121
Mailing Address - Street 1:2467 US HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3762
Mailing Address - Country:US
Mailing Address - Phone:732-922-4121
Mailing Address - Fax:732-922-8126
Practice Address - Street 1:2467 US HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-3762
Practice Address - Country:US
Practice Address - Phone:732-922-4121
Practice Address - Fax:732-922-8126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006127003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2052431OtherPK
NJ5374707Medicaid
NJ5374707Medicaid