Organization
108 LACEY ROAD LLC
Active
Other names
FOODTOWN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SANJAY SHAH (OWNER)
(732) 350-7550
Entity
Organization
Contact information
Practice address
108 LACEY RD, WHITING, NJ 08759-1337
(732) 350-7550
(732) 350-7552
Mailing address
108 LACEY RD, WHITING, NJ 08759-1337
(732) 350-7550
(732) 350-7552
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00700300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3196688
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/06/2009
Last updated
02/24/2010
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