Provider Demographics
NPI:1982148466
Name:MEMORIAL SLOAN KETTERING CANCER CENTER
Entity Type:Organization
Organization Name:MEMORIAL SLOAN KETTERING CANCER CENTER
Other - Org Name:MEMORIAL SLOAN KETTERING AT MONMOUTH RETAIL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-639-2206
Mailing Address - Street 1:1275 YORK AVE RM H-313
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-2206
Mailing Address - Fax:
Practice Address - Street 1:480 RED HILL RD
Practice Address - Street 2:SUITE 1136
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-3052
Practice Address - Country:US
Practice Address - Phone:848-225-6060
Practice Address - Fax:201-691-6676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
NJ28RS007525003336C0002X, 3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166963OtherPK