Provider Demographics
NPI:1275793960
Name:CUREXA- EAST II, LLC
Entity Type:Organization
Organization Name:CUREXA- EAST II, LLC
Other - Org Name:CUREXA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:KELSO
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:855-927-0390
Mailing Address - Street 1:236 E JIMMIE LEEDS RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4134
Mailing Address - Country:US
Mailing Address - Phone:855-927-0390
Mailing Address - Fax:855-927-0392
Practice Address - Street 1:236 E JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4134
Practice Address - Country:US
Practice Address - Phone:855-927-0390
Practice Address - Fax:855-927-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH309023336C0003X
IA49363336C0003X
MDP076943336C0003X
IN64002509A3336C0003X
OHNRP.022794050-033336C0003X
IL0540206993336C0003X
PANP0002893336C0003X
NJ28RS006806003336C0003X
AK1265603336C0003X
NE11953336C0003X
DEA9-00021283336C0003X
GAPHNR0013563336C0003X
NY0360783336C0003X
NVPH038893336C0003X
CTPCN.00033693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102467890Medicaid
2056311OtherPK
NJ28RS00785700OtherHOME STATE ISSUED PHARMACY LICENSE
NJ0183822Medicaid