Provider Demographics
NPI:1851460653
Name:RARITAN BAY PHARMACY INC
Entity type:Organization
Organization Name:RARITAN BAY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTROUS
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:551-221-3506
Mailing Address - Street 1:501 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3653
Mailing Address - Country:US
Mailing Address - Phone:732-376-1600
Mailing Address - Fax:732-376-1602
Practice Address - Street 1:501 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3653
Practice Address - Country:US
Practice Address - Phone:732-376-1600
Practice Address - Fax:732-376-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI23166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0067288Medicaid
NJ5441420001Medicare ID - Type Unspecified