Provider Demographics
NPI:1811007123
Name:LEXINGTON DRUG COMPANY OF NJ, INC.
Entity Type:Organization
Organization Name:LEXINGTON DRUG COMPANY OF NJ, INC.
Other - Org Name:LEXINGTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:908-355-2020
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889-0176
Mailing Address - Country:US
Mailing Address - Phone:908-355-2020
Mailing Address - Fax:
Practice Address - Street 1:1037 N BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-2748
Practice Address - Country:US
Practice Address - Phone:908-355-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01419200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4381602Medicaid
NJ1077470001Medicare ID - Type Unspecified