Provider Demographics
NPI:1275047532
Name:AERENSON ROAD PHARMACY, LLC
Entity Type:Organization
Organization Name:AERENSON ROAD PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ARASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-251-1885
Mailing Address - Street 1:115 AERENSON DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1241
Mailing Address - Country:US
Mailing Address - Phone:302-430-0995
Mailing Address - Fax:302-430-0995
Practice Address - Street 1:115 AERENSON DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1241
Practice Address - Country:US
Practice Address - Phone:302-430-0995
Practice Address - Fax:302-430-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-24
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA3-00010153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy