Provider Demographics
NPI:1568521565
Name:COLTS NECK FAMILY DRUGS INC
Entity Type:Organization
Organization Name:COLTS NECK FAMILY DRUGS INC
Other - Org Name:FAMILY PHARMACY ON 34
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTROKOSTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-677-3380
Mailing Address - Street 1:11 EQUINOX LN
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8652
Mailing Address - Country:US
Mailing Address - Phone:732-252-5615
Mailing Address - Fax:
Practice Address - Street 1:293 RT 34
Practice Address - Street 2:SUITE 201
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722
Practice Address - Country:US
Practice Address - Phone:732-677-3380
Practice Address - Fax:732-677-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006663003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3194064OtherNCPDP PROVIDER IDENTIFICATION NUMBER