Organization
MADISON AVE PHARMACY LLC
Active
Other names
Madison Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID SEGAL (OWNER)
(908) 745-1020
Entity
Organization
Contact information
Practice address
400 MADISON AVE, LAKEWOOD, NJ 08701-3225
(732) 370-4200
(732) 328-2233
Mailing address
400 MADISON AVE, LAKEWOOD, NJ 08701-3225
(732) 370-4200
(732) 328-2233
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00721100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0366196
—
NJ
01
—
2136670
PK
—
Enumeration date
08/23/2012
Last updated
01/30/2014
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