# BALD EAGLE PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BALD EAGLE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154336790
- **Authorized official:** ANTHONY GUERCIO (MANAGER)
- **Authorized official phone:** (973) 728-2007

## Contact information

- **Practice address:** 610 VALLEY HEALTH PLZ, PARAMUS, NJ 07652
- **Practice address phone:** (201) 225-0970
- **Practice address fax:** (201) 225-0973
- **Mailing address:** 14 FRANKLIN ST FL 2, BELLEVILLE, NJ 07109-1134
- **Mailing address phone:** (973) 728-2007
- **Mailing address fax:** (973) 728-1009

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 28RI02690900 | NJ | Yes |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 06/07/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0093181 | — | NJ |
| 01 | — | 3193391 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |