Provider Demographics
NPI:1629007745
Name:TWIN CITY PHARMACY INC
Entity Type:Organization
Organization Name:TWIN CITY PHARMACY INC
Other - Org Name:TWIN CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHNAULT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:908-755-7696
Mailing Address - Street 1:1708 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5519
Mailing Address - Country:US
Mailing Address - Phone:908-755-7696
Mailing Address - Fax:908-755-6003
Practice Address - Street 1:1708 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5519
Practice Address - Country:US
Practice Address - Phone:908-755-7696
Practice Address - Fax:908-755-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
NJ28RS006691003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0132977Medicaid
NJ0132993Medicaid
2056495OtherPK
0437420001Medicare NSC