Organization
THE ESTAUGH
Active
Other names
MEDFORD LEAS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK SIMMONS PHARM D (PHCY DIR)
(609) 654-3391
Entity
Organization
Contact information
Practice address
1 MEDFORD LEAS, MEDFORD, NJ 08055-2254
(609) 654-3269
(609) 257-0827
Mailing address
1 MEDFORD LEAS, MEDFORD, NJ 08055-2254
(609) 654-3269
(609) 257-0827
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00192000
NJ
3336L0003X
Long Term Care Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2056046
PK
—
05
—
4303504
—
NJ
Enumeration date
06/20/2006
Last updated
07/20/2016
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