Provider Demographics
NPI:1417058439
Name:MARG PHARMACY INC
Entity Type:Organization
Organization Name:MARG PHARMACY INC
Other - Org Name:MEDLY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP PHARMACY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-254-9011
Mailing Address - Street 1:40 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2262
Mailing Address - Country:US
Mailing Address - Phone:908-725-0585
Mailing Address - Fax:908-725-0587
Practice Address - Street 1:40 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876
Practice Address - Country:US
Practice Address - Phone:908-725-0585
Practice Address - Fax:908-725-0587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINDENWOOD HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NJ28RS004978003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0575739Medicaid
NJAW8765779OtherDEA#
NJ6279503Medicaid
NJ3135868OtherNCPDP#