Provider Demographics
NPI:1932244563
Name:ROXY PHARMACY INC
Entity Type:Organization
Organization Name:ROXY PHARMACY INC
Other - Org Name:ROXY PHARMACY II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANSELM
Authorized Official - Middle Name:ANYANWU
Authorized Official - Last Name:ESOMONU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:978-242-8001
Mailing Address - Street 1:1275E STUYVESANT AVE STE E
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3851
Mailing Address - Country:US
Mailing Address - Phone:973-242-8001
Mailing Address - Fax:973-242-8004
Practice Address - Street 1:1275E STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3851
Practice Address - Country:US
Practice Address - Phone:973-242-8001
Practice Address - Fax:973-242-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
NJ28RS05513003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7497504Medicaid
2053863OtherPK
4111490001Medicare NSC