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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