Provider Demographics
NPI:1508953704
Name:WOODBINE PHARMACY INC
Entity Type:Organization
Organization Name:WOODBINE PHARMACY INC
Other - Org Name:FAMILY HEALTH AND PRESC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:NEFF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:609-861-5124
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08270-0438
Mailing Address - Country:US
Mailing Address - Phone:609-861-1248
Mailing Address - Fax:609-861-1248
Practice Address - Street 1:621 DEHIRSCH AVE
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:NJ
Practice Address - Zip Code:08270-2338
Practice Address - Country:US
Practice Address - Phone:609-861-5124
Practice Address - Fax:609-861-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS002766003336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2054686OtherPK
NJ4306406Medicaid
NJ4306406Medicaid