Provider Demographics
NPI:1467776690
Name:MULE ROAD PHARMACY LLC
Entity Type:Organization
Organization Name:MULE ROAD PHARMACY LLC
Other - Org Name:MULE ROAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MALAV
Authorized Official - Middle Name:
Authorized Official - Last Name:KANUGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-244-3737
Mailing Address - Street 1:600 MULE ROAD
Mailing Address - Street 2:UNIT-2, PLAZA -3
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757
Mailing Address - Country:US
Mailing Address - Phone:732-244-3737
Mailing Address - Fax:732-244-3767
Practice Address - Street 1:600 MULE RD
Practice Address - Street 2:UNIT-2, PLAZA -3
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-6461
Practice Address - Country:US
Practice Address - Phone:732-244-3737
Practice Address - Fax:732-244-3767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NJ28RS007016003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124433OtherPK
NJ6478800001Medicare NSC