Provider Demographics
NPI:1386425270
Name:UNDEFINED PHARMACY, LLC
Entity type:Organization
Organization Name:UNDEFINED PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD, RPH, ESQ
Authorized Official - Phone:908-430-0831
Mailing Address - Street 1:266 KING GEORGE RD STE C2
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5187
Mailing Address - Country:US
Mailing Address - Phone:908-430-7379
Mailing Address - Fax:
Practice Address - Street 1:266 KING GEORGE RD STE C2
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5187
Practice Address - Country:US
Practice Address - Phone:908-430-7379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy