Provider Demographics
NPI:1942632849
Name:LAMBERTVILLE PHARMACY CORP
Entity Type:Organization
Organization Name:LAMBERTVILLE PHARMACY CORP
Other - Org Name:THE MEDICINE SHOPPE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-397-8889
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08530-0159
Mailing Address - Country:US
Mailing Address - Phone:609-397-8889
Mailing Address - Fax:609-397-8383
Practice Address - Street 1:1509 ROUTE 179
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08530-3447
Practice Address - Country:US
Practice Address - Phone:609-397-8889
Practice Address - Fax:609-397-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00586000333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141582OtherPK
7013750001Medicare NSC