Provider Demographics
NPI:1437665999
Name:LARCHMONT PHARMACY LTC
Entity Type:Organization
Organization Name:LARCHMONT PHARMACY LTC
Other - Org Name:LARCHMONT PHARMACY LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VU
Authorized Official - Middle Name:
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-235-8888
Mailing Address - Street 1:200 LARCHMONT BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3379
Mailing Address - Country:US
Mailing Address - Phone:856-235-8888
Mailing Address - Fax:856-235-8881
Practice Address - Street 1:200 LARCHMONT BLVD STE 5
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3379
Practice Address - Country:US
Practice Address - Phone:856-235-8888
Practice Address - Fax:856-235-8881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LARCHMONT PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007459003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy