Provider Demographics
NPI:1386078889
Name:TITAN RX
Entity type:Organization
Organization Name:TITAN RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:856-751-8356
Mailing Address - Street 1:1930 ROUTE 70 E
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2150
Mailing Address - Country:US
Mailing Address - Phone:856-751-8356
Mailing Address - Fax:856-751-8091
Practice Address - Street 1:1930 ROUTE 70 E
Practice Address - Street 2:SUITE B-1
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-751-8356
Practice Address - Fax:856-751-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28IS00727900333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy