Provider Demographics
NPI:1528474665
Name:OLD STONE PHARMACY
Entity type:Organization
Organization Name:OLD STONE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRICKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-746-4555
Mailing Address - Street 1:28 W GRAND AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-2100
Mailing Address - Country:US
Mailing Address - Phone:201-746-4555
Mailing Address - Fax:201-745-4989
Practice Address - Street 1:28 W GRAND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-2100
Practice Address - Country:US
Practice Address - Phone:201-746-4555
Practice Address - Fax:201-745-4989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007346003336S0011X, 3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy