Organization
MANAGUA INC
Active
Other names
FAMILY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MOHIT PATEL (FRONT STORE MANAGER)
(856) 627-0004
Entity
Organization
Contact information
Practice address
581 BLACKWOOD CLEMENTON RD, LINDENWOLD, NJ 08021-5901
(856) 627-0004
(856) 627-2244
Mailing address
581 BLACKWOOD CLEMENTON RD, LINDENWOLD, NJ 08021-5901
(856) 627-0004
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
28RS00688300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3144401
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/18/2006
Last updated
07/23/2009
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