Provider Demographics
NPI:1609167493
Name:TOWN & COUNTRY COMPOUNDING AND CONSULTATION LLC, SERIES T&C NEUROMAX
Entity Type:Organization
Organization Name:TOWN & COUNTRY COMPOUNDING AND CONSULTATION LLC, SERIES T&C NEUROMAX
Other - Org Name:T&CNEUROMAX SPECIALTY HOME INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-447-2020
Mailing Address - Street 1:535 E CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2922
Mailing Address - Country:US
Mailing Address - Phone:201-447-2020
Mailing Address - Fax:
Practice Address - Street 1:535 E CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2922
Practice Address - Country:US
Practice Address - Phone:484-410-3171
Practice Address - Fax:866-587-8915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN & COUNTRY COMPOUNDING AND CONSULTATION SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-27
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006241003336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0000710Medicaid
NJ0000710Medicaid