Provider Demographics
NPI:1497998389
Name:BARNEGAT PHARMACY LLC
Entity Type:Organization
Organization Name:BARNEGAT PHARMACY LLC
Other - Org Name:JERSEY SHORE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:609-660-1111
Mailing Address - Street 1:580 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2594
Mailing Address - Country:US
Mailing Address - Phone:609-660-1111
Mailing Address - Fax:609-660-0101
Practice Address - Street 1:580 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2594
Practice Address - Country:US
Practice Address - Phone:609-660-1111
Practice Address - Fax:609-660-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
NJ28RS006890003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119887OtherPK
NJ0208329Medicaid