Provider Demographics
NPI:1336648674
Name:AERENSON PHARMACY
Entity Type:Organization
Organization Name:AERENSON PHARMACY
Other - Org Name:PILLBOX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-430-0995
Mailing Address - Street 1:115 AERENSON DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1241
Mailing Address - Country:US
Mailing Address - Phone:302-430-0995
Mailing Address - Fax:302-430-0996
Practice Address - Street 1:115 AERENSON DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1241
Practice Address - Country:US
Practice Address - Phone:302-430-0995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250496064Medicaid