Provider Demographics
NPI:1275774200
Name:RARITAN APOTHECARY LLC
Entity Type:Organization
Organization Name:RARITAN APOTHECARY LLC
Other - Org Name:RARITAN APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:908-722-3800
Mailing Address - Street 1:25 W SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-2027
Mailing Address - Country:US
Mailing Address - Phone:908-722-3800
Mailing Address - Fax:908-722-3850
Practice Address - Street 1:25 W SOMERSET ST
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-2027
Practice Address - Country:US
Practice Address - Phone:908-722-3800
Practice Address - Fax:908-722-3850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-21
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006897003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119545OtherPK
NJ0208892Medicaid