Provider Demographics
NPI:1770733693
Name:SN SUPREME LLC
Entity type:Organization
Organization Name:SN SUPREME LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHARMACY OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATMON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:609-598-2453
Mailing Address - Street 1:1301 N 10TH ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-2033
Mailing Address - Country:US
Mailing Address - Phone:877-244-6558
Mailing Address - Fax:856-210-1556
Practice Address - Street 1:1301 N 10TH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2033
Practice Address - Country:US
Practice Address - Phone:877-244-6558
Practice Address - Fax:856-210-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-28
Last Update Date:2008-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006793003336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy