Provider Demographics
NPI:1407887433
Name:PLAINSBORO PHARMACY LLC
Entity Type:Organization
Organization Name:PLAINSBORO PHARMACY LLC
Other - Org Name:PLAINSBORO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:YOUSRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKSOUD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:609-750-0101
Mailing Address - Street 1:9 SCHALKS CROSSING RD STE 712
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1618
Mailing Address - Country:US
Mailing Address - Phone:609-750-0101
Mailing Address - Fax:609-750-0707
Practice Address - Street 1:9 SCHALKS CROSSING RD STE 712
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1618
Practice Address - Country:US
Practice Address - Phone:609-750-0101
Practice Address - Fax:609-750-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NJ28RS006621003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0128911Medicaid
2055946OtherPK
NJ0128911Medicaid