Provider Demographics
NPI:1679887566
Name:STATION PHARMACY LLC
Entity Type:Organization
Organization Name:STATION PHARMACY LLC
Other - Org Name:BOUND BROOK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-369-6081
Mailing Address - Street 1:303 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-2096
Mailing Address - Country:US
Mailing Address - Phone:732-369-6081
Mailing Address - Fax:732-667-5350
Practice Address - Street 1:303 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-2096
Practice Address - Country:US
Practice Address - Phone:732-369-6081
Practice Address - Fax:732-667-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007035003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3197159OtherNCPDP PROVIDER IDENTIFICATION NUMBER