Provider Demographics
NPI:1013953470
Name:COURT HOUSE PROF PHCY INC
Entity Type:Organization
Organization Name:COURT HOUSE PROF PHCY INC
Other - Org Name:COURT HOUSE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MELROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-465-4661
Mailing Address - Street 1:315 RT 9 S STE 3
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY CT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-1960
Mailing Address - Country:US
Mailing Address - Phone:609-465-4661
Mailing Address - Fax:609-465-4379
Practice Address - Street 1:315 RT 9 S STE 3
Practice Address - Street 2:
Practice Address - City:CAPE MAY CT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1960
Practice Address - Country:US
Practice Address - Phone:609-465-4661
Practice Address - Fax:609-465-4379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS00427800333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3130755OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NJ4406702Medicaid
NJ4406702Medicaid