Organization
SOUTH ORANGE PHARMACY LLC
Active
Other names
South Orange Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER OTTO (OWNER)
(973) 821-5414
Entity
Organization
Contact information
Practice address
73 S ORANGE AVE, SOUTH ORANGE, NJ 07079-1715
(973) 821-5414
(973) 275-5220
Mailing address
73 S ORANGE AVE, SOUTH ORANGE, NJ 07079-1715
(973) 821-5414
(973) 275-5220
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00687000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0193381
—
NJ
01
—
2117729
PK
—
05
—
6227070001
—
NJ
Enumeration date
10/01/2008
Last updated
12/20/2016
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