Provider Demographics
NPI:1437293529
Name:MAIN PHARMACY OF BOONTON INC
Entity Type:Organization
Organization Name:MAIN PHARMACY OF BOONTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FAUST
Authorized Official - Last Name:CANTALUPPI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:973-334-0519
Mailing Address - Street 1:203 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1749
Mailing Address - Country:US
Mailing Address - Phone:973-334-0519
Mailing Address - Fax:973-334-9390
Practice Address - Street 1:203 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1749
Practice Address - Country:US
Practice Address - Phone:973-334-0519
Practice Address - Fax:973-334-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00460100333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4987900Medicaid
NJ4987900Medicaid