Organization
REVERENCE DISCOUNT PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WIDLYNE RUFFIN (PHARMACIST)
(609) 445-4423
Entity
Organization
Contact information
Practice address
912 S MAIN ST, PLEASANTVILLE, NJ 08232-3618
(609) 445-4423
(609) 445-4423
Mailing address
5 MOONLIGHT DR, EGG HARBOR TWP, NJ 08234-4927
(609) 904-2540
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336M0002X
Mail Order Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2168126
PK
—
Enumeration date
03/01/2017
Last updated
04/05/2017
Update your record
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