Provider Demographics
NPI:1922427921
Name:NEIL PHARMACY LLC
Entity Type:Organization
Organization Name:NEIL PHARMACY LLC
Other - Org Name:SMITH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:AARTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-661-6625
Mailing Address - Street 1:91 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4413
Mailing Address - Country:US
Mailing Address - Phone:732-661-6625
Mailing Address - Fax:732-661-6817
Practice Address - Street 1:91 SMITH ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4413
Practice Address - Country:US
Practice Address - Phone:732-661-6625
Practice Address - Fax:732-661-6817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007323003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144989OtherPK
NJ0439134Medicaid
NJ0439134Medicaid