Provider Demographics
NPI:1205934239
Name:PRINCETON PHARMACY
Entity type:Organization
Organization Name:PRINCETON PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAGOREOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:609-924-4545
Mailing Address - Street 1:36 UNIVERSITY PL
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5116
Mailing Address - Country:US
Mailing Address - Phone:609-924-4545
Mailing Address - Fax:609-921-2467
Practice Address - Street 1:36 UNIVERSITY PL
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5116
Practice Address - Country:US
Practice Address - Phone:609-924-4545
Practice Address - Fax:609-921-2467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS004446003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2051757OtherPK
NJ4419707Medicaid