Provider Demographics
NPI:1417044611
Name:COMMUNITY SURGICAL SUPPLY OF TOMS RIVER INC
Entity Type:Organization
Organization Name:COMMUNITY SURGICAL SUPPLY OF TOMS RIVER INC
Other - Org Name:COMMUNITY SURGICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KALEMBA
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:732-349-2990
Mailing Address - Street 1:PO BOX 4686
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-4686
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:163 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8046
Practice Address - Country:US
Practice Address - Phone:732-349-2990
Practice Address - Fax:732-505-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS002118003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2056916OtherPK
NJ4265904Medicaid
NJ4265904Medicaid