Provider Demographics
NPI:1760424428
Name:HUNTERDON REGIONAL PHARMACY INC
Entity Type:Organization
Organization Name:HUNTERDON REGIONAL PHARMACY INC
Other - Org Name:HUNTERDON REGIONAL PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLY
Authorized Official - Middle Name:I
Authorized Official - Last Name:NASSER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:732-788-6586
Mailing Address - Street 1:2100 WESCOTT DR
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4603
Mailing Address - Country:US
Mailing Address - Phone:908-788-6586
Mailing Address - Fax:908-788-6587
Practice Address - Street 1:2100 WESCOTT DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4603
Practice Address - Country:US
Practice Address - Phone:908-788-6586
Practice Address - Fax:908-788-6587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NJ28RS006205003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0040738Medicaid
2055211OtherPK
4794500001Medicare NSC