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Organization
BALD EAGLE PHARMACY LLC
Active
Organization
BALD EAGLE PHARMACY LLC
Active
Other names
BALD EAGLE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY GUERCIO (MANAGER)
(973) 728-2007
Entity
Organization
Contact information
Practice address
610 VALLEY HEALTH PLZ, PARAMUS, NJ 07652
(201) 225-0970
(201) 225-0973
Mailing address
14 FRANKLIN ST FL 2, BELLEVILLE, NJ 07109-1134
(973) 728-2007
(973) 728-1009
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
28RI02690900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0093181
—
NJ
01
—
3193391
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/30/2006
Last updated
06/07/2018
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