Provider Demographics
NPI:1386903433
Name:PHARMEDIUM SERVICES, LLC
Entity type:Organization
Organization Name:PHARMEDIUM SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRUZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:847-457-2302
Mailing Address - Street 1:43 DISTRIBUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-6005
Mailing Address - Country:US
Mailing Address - Phone:732-287-8655
Mailing Address - Fax:
Practice Address - Street 1:43 DISTRIBUTION BLVD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-6005
Practice Address - Country:US
Practice Address - Phone:732-287-8655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00632500333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy