Provider Demographics
NPI:1790839140
Name:STELTON PHARMACY INC
Entity Type:Organization
Organization Name:STELTON PHARMACY INC
Other - Org Name:STELTON PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-424-8080
Mailing Address - Street 1:179 STELTON RD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3250
Mailing Address - Country:US
Mailing Address - Phone:732-424-8080
Mailing Address - Fax:732-424-8989
Practice Address - Street 1:179 STELTON RD
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3250
Practice Address - Country:US
Practice Address - Phone:732-424-8080
Practice Address - Fax:732-424-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006501003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0074667Medicaid
2055553OtherPK
5469160001Medicare NSC
NJ0074667Medicaid