Provider Demographics
NPI:1710425566
Name:SPECIALTY SCRIPT FREEHOLD LLC
Entity Type:Organization
Organization Name:SPECIALTY SCRIPT FREEHOLD LLC
Other - Org Name:CENTRASTATE SPECIALTY SCRIPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:RANI
Authorized Official - Last Name:KANTAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:732-414-1977
Mailing Address - Street 1:901 W MAIN ST
Mailing Address - Street 2:SUITE # 162
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-414-1977
Mailing Address - Fax:732-414-1980
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:SUITE # 162
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-414-1977
Practice Address - Fax:732-414-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00698600OtherNJ STATE LICENSE #