Organization
SPECIALTY SCRIPT FREEHOLD LLC
Active
Other names
Centrastate specialty script
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDHYA RANI KANTAMANENI M.S (MEMBER/PHARMACIST)
(732) 414-1977
Entity
Organization
Contact information
Practice address
901 W MAIN ST, SUITE # 162, FREEHOLD, NJ 07728-2537
(732) 414-1977
(732) 414-1980
Mailing address
901 W MAIN ST, SUITE # 162, FREEHOLD, NJ 07728-2537
(732) 414-1977
(732) 414-1980
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28RS00698600
NJ STATE LICENSE #
NJ
Enumeration date
02/01/2017
Last updated
02/01/2017
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