Organization
MEDICINE MAN RX LLC
Active
Other names
Medicine Man Pharmacy & Compounding
Organization subpart
No
Provider details
NPI number
Authorized official
PANKIT SUTARIA (PRESIDENT)
(201) 942-9777
Entity
Organization
Contact information
Practice address
511 WASHINGTON ST, HOBOKEN, NJ 07030-4993
(201) 942-9777
(201) 942-9779
Mailing address
511 WASHINGTON ST, HOBOKEN, NJ 07030-4993
(201) 942-9777
(201) 942-9779
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00722900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0383911
—
NJ
01
—
2153660
PK
—
Enumeration date
11/16/2012
Last updated
10/02/2024
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