Provider Demographics
NPI:1417598095
Name:CALDWELL PHARMACY
Entity Type:Organization
Organization Name:CALDWELL PHARMACY
Other - Org Name:CALDWELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-300-5897
Mailing Address - Street 1:28 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6441
Mailing Address - Country:US
Mailing Address - Phone:845-300-5897
Mailing Address - Fax:973-808-1818
Practice Address - Street 1:808 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6700
Practice Address - Country:US
Practice Address - Phone:973-808-1800
Practice Address - Fax:973-808-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0720135Medicaid