Provider Demographics
NPI:1336154970
Name:937 SOUTHWOOD LLC
Entity Type:Organization
Organization Name:937 SOUTHWOOD LLC
Other - Org Name:SOUTHWOOD RITA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JIGNESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:908-862-4444
Mailing Address - Street 1:937 S WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4567
Mailing Address - Country:US
Mailing Address - Phone:908-862-4444
Mailing Address - Fax:908-862-6044
Practice Address - Street 1:937 S WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4567
Practice Address - Country:US
Practice Address - Phone:908-862-4444
Practice Address - Fax:908-862-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006612003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0102075Medicaid
3110929OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ0102067Medicaid