Provider Demographics
NPI:1952451288
Name:RESTORATION PHARMACY LLC
Entity Type:Organization
Organization Name:RESTORATION PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:IKENNA
Authorized Official - Last Name:EZEONYIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-688-8866
Mailing Address - Street 1:2153 TYLER STREET
Mailing Address - Street 2:1385 STUYVESANT ST
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083
Mailing Address - Country:US
Mailing Address - Phone:908-688-7575
Mailing Address - Fax:908-688-8866
Practice Address - Street 1:2153 TYLER STREET
Practice Address - Street 2:1385 STUYVESANT ST
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:908-688-7575
Practice Address - Fax:908-688-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy