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Organization
FANWOOD RX CORP
Active
Organization
FANWOOD RX CORP
Active
Other names
Fanwood Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITUL P PATEL PHARMD (PHARMACIST IN CHARGE)
(908) 680-6936
Entity
Organization
Contact information
Practice address
45 S MARTINE AVE, FANWOOD, NJ 07023-1216
(908) 680-6936
(908) 680-6937
Mailing address
1 TED LIGHT WAY, PISCATAWAY, NJ 08854
(848) 228-9655
(908) 680-6937
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
28RS00749500
NJ
3336C0004X
Compounding Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
—
NULL
3336S0011X
Specialty Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0547891
—
NJ
01
—
2160637
PK
—
Enumeration date
06/05/2016
Last updated
08/15/2024
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