Provider Demographics
NPI:1932217684
Name:FORKED RIVER PHARMACY
Entity Type:Organization
Organization Name:FORKED RIVER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-693-2868
Mailing Address - Street 1:605 RT. 9
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-0447
Mailing Address - Country:US
Mailing Address - Phone:609-693-2868
Mailing Address - Fax:609-971-1640
Practice Address - Street 1:605 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-4827
Practice Address - Country:US
Practice Address - Phone:609-693-2868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0437750001Medicare NSC