Provider Demographics
NPI:1710053814
Name:COLTS NECK APOTHECARY INC
Entity Type:Organization
Organization Name:COLTS NECK APOTHECARY INC
Other - Org Name:COLTS NECK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:TOTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:732-780-5480
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:420 STATE ROUTE 34 STE 309
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2517
Mailing Address - Country:US
Mailing Address - Phone:732-780-5480
Mailing Address - Fax:732-521-5481
Practice Address - Street 1:420 STATE ROUTE 34 STE 309
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2517
Practice Address - Country:US
Practice Address - Phone:732-780-5480
Practice Address - Fax:732-521-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00600900183500000X, 3336C0003X
333600000X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8630305Medicaid
2057408OtherPK
NJ8630305Medicaid