Provider Demographics
NPI:1497734131
Name:MONROE PARK PHARMACY,INC.
Entity Type:Organization
Organization Name:MONROE PARK PHARMACY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NITIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANDWALA
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:732-251-3000
Mailing Address - Street 1:357 SPOTSWOOD ENGLISHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-8600
Mailing Address - Country:US
Mailing Address - Phone:732-251-3000
Mailing Address - Fax:
Practice Address - Street 1:357 SPOTSWOOD ENGLISHTOWN RD
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-8600
Practice Address - Country:US
Practice Address - Phone:732-251-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00649500333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0075485Medicaid
NJ0075485Medicaid