Organization
MADURA PHARMACY LLC
Active
Other names
Madura Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE WOLPIN (AUTH REP)
(732) 721-1732
Entity
Organization
Contact information
Practice address
115 N BROADWAY, SOUTH AMBOY, NJ 08879-1660
(732) 721-1732
(732) 721-5840
Mailing address
115 N BROADWAY, SOUTH AMBOY, NJ 08879-1660
(732) 721-1732
(732) 721-5840
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00116700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3115234
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
4249801
—
NJ
Enumeration date
06/18/2006
Last updated
06/16/2011
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