Provider Demographics
NPI:1679041628
Name:PHARMACOTHERAPY LLC
Entity Type:Organization
Organization Name:PHARMACOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF NURSING PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:RAMBARAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:908-553-7094
Mailing Address - Street 1:58 BLACKBURN RD
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2522
Mailing Address - Country:US
Mailing Address - Phone:908-553-7094
Mailing Address - Fax:
Practice Address - Street 1:58 BLACKBURN RD
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205
Practice Address - Country:US
Practice Address - Phone:908-553-7094
Practice Address - Fax:908-751-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1114471372Medicaid