Provider Demographics
NPI:1215963418
Name:CUREXA - EAST, LLC
Entity type:Organization
Organization Name:CUREXA - EAST, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT AND PHARMACIST IN CH
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:KELSO
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:855-927-0390
Mailing Address - Street 1:3007 OCEAN HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-7749
Mailing Address - Country:US
Mailing Address - Phone:855-927-0390
Mailing Address - Fax:855-927-0392
Practice Address - Street 1:3007 OCEAN HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-7749
Practice Address - Country:US
Practice Address - Phone:855-927-0390
Practice Address - Fax:855-927-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS006264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00785600OtherHOME STATE ISSUED PHARMACY LICENSE
NJ3145403OtherNCPDP
NJ0012424Medicaid