Provider Demographics
NPI:1831135292
Name:ALLENTOWN VILLAGE PHARMACY INC
Entity Type:Organization
Organization Name:ALLENTOWN VILLAGE PHARMACY INC
Other - Org Name:VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPIC CO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERVIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MHA
Authorized Official - Phone:609-259-2202
Mailing Address - Street 1:1278 YARDVILLE ALLENTOWN RD STE 5
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-1866
Mailing Address - Country:US
Mailing Address - Phone:609-259-2202
Mailing Address - Fax:609-259-6735
Practice Address - Street 1:1278 YARDVILLE ALLENTOWN RD STE 5
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08501-1866
Practice Address - Country:US
Practice Address - Phone:609-259-2202
Practice Address - Fax:609-259-6735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NJ28RS006519003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055350OtherPK
NJ0080586Medicaid
NJ0080586Medicaid