Provider Demographics
NPI:1568405314
Name:CAMPBELLS NEPTUNE PHARMACY LLC
Entity Type:Organization
Organization Name:CAMPBELLS NEPTUNE PHARMACY LLC
Other - Org Name:CAMPBELLS PHARMACY AT FOODTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-974-2929
Mailing Address - Street 1:116 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6400
Mailing Address - Country:US
Mailing Address - Phone:732-776-7575
Mailing Address - Fax:732-776-7766
Practice Address - Street 1:116 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-6400
Practice Address - Country:US
Practice Address - Phone:732-776-7575
Practice Address - Fax:732-776-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006545003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055756OtherPK
NJ0090859Medicaid
NJ0090859Medicaid
3193240OtherOTHER ID NUMBER-COMMERCIAL NUMBER