Provider Demographics
NPI:1912241340
Name:GENERATION PHARMACY GROUP, LLC.
Entity Type:Organization
Organization Name:GENERATION PHARMACY GROUP, LLC.
Other - Org Name:GENERATION PHARMACY GROUP, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WITZAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-299-2500
Mailing Address - Street 1:85 FULTON STREET
Mailing Address - Street 2:SUITE 9A
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005
Mailing Address - Country:US
Mailing Address - Phone:973-299-2500
Mailing Address - Fax:973-265-0005
Practice Address - Street 1:85 FULTON STREET
Practice Address - Street 2:SUITE 9A
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005
Practice Address - Country:US
Practice Address - Phone:973-299-2500
Practice Address - Fax:973-265-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00722500333600000X
3336C0003X, 3336I0012X, 3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3199204OtherNCPDP PROVIDER IDENTIFICATION NUMBER