Provider Demographics
NPI:1639766777
Name:ST JOSEPHS HEALTH PHARMACY, LLC
Entity Type:Organization
Organization Name:ST JOSEPHS HEALTH PHARMACY, LLC
Other - Org Name:ST. JOSEPH'S HEALTH PHARMACY-WAYNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-754-3029
Mailing Address - Street 1:224 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2168
Mailing Address - Country:US
Mailing Address - Phone:973-389-5270
Mailing Address - Fax:973-389-5271
Practice Address - Street 1:224 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2168
Practice Address - Country:US
Practice Address - Phone:973-389-5270
Practice Address - Fax:973-389-5271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JOSEPHS UNIVERSITY MEDICAL CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-23
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00781400OtherBOARD OF PHARMACY