Provider Demographics
NPI:1154336550
Name:PARKE-TOWNE PHARMACY
Entity type:Organization
Organization Name:PARKE-TOWNE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAILER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:856-845-5225
Mailing Address - Street 1:1010 HESSIAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08063
Mailing Address - Country:US
Mailing Address - Phone:856-845-5225
Mailing Address - Fax:856-845-0350
Practice Address - Street 1:1010 HESSIAN AVENUE
Practice Address - Street 2:
Practice Address - City:NATIONAL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08063
Practice Address - Country:US
Practice Address - Phone:856-845-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ0885333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4278500Medicaid
NJ4278500Medicaid