Provider Demographics
NPI:1821536582
Name:TICETOWN PHARMACY & SURGICAL INC.
Entity Type:Organization
Organization Name:TICETOWN PHARMACY & SURGICAL INC.
Other - Org Name:THE WELLNESS CENTER PHARMACY & SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SNEHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-679-3555
Mailing Address - Street 1:3117 US HIGHWAY 9
Mailing Address - Street 2:SUITE 3123
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857
Mailing Address - Country:US
Mailing Address - Phone:732-679-3555
Mailing Address - Fax:
Practice Address - Street 1:3117 US HIGHWAY 9
Practice Address - Street 2:SUITE 3123
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2690
Practice Address - Country:US
Practice Address - Phone:732-679-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007006003336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6483650001Medicare NSC