Provider Demographics
NPI:1629140322
Name:POETS PHARMACY CORPORATION
Entity Type:Organization
Organization Name:POETS PHARMACY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:KORN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-946-9173
Mailing Address - Street 1:460 COUNTY ROAD 520
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1041
Mailing Address - Country:US
Mailing Address - Phone:732-946-9173
Mailing Address - Fax:732-946-4194
Practice Address - Street 1:460 COUNTY ROAD 520
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1041
Practice Address - Country:US
Practice Address - Phone:732-946-9173
Practice Address - Fax:732-946-4194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00573800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3129740OtherNABP
NJ8173010Medicaid
NJ3129740OtherNABP