Provider Demographics
NPI:1124348305
Name:SMASH MEDICINE LLC
Entity type:Organization
Organization Name:SMASH MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARFARAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:609-234-0567
Mailing Address - Street 1:17 OAKSHADE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-5162
Mailing Address - Country:US
Mailing Address - Phone:609-234-0567
Mailing Address - Fax:
Practice Address - Street 1:836 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-4002
Practice Address - Country:US
Practice Address - Phone:609-234-0567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy