Provider Demographics
NPI:1962811125
Name:BROADWAY DISCOUNT PHARMACY INC
Entity type:Organization
Organization Name:BROADWAY DISCOUNT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-963-6333
Mailing Address - Street 1:315 S. BROADWAY
Mailing Address - Street 2:BROADWAY DISCOUNT PHARMACY INC
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1208
Mailing Address - Country:US
Mailing Address - Phone:856-963-6333
Mailing Address - Fax:856-963-6332
Practice Address - Street 1:315 S. BROADWAY
Practice Address - Street 2:BROADWAY DISCOUNT PHARMACY INC
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1208
Practice Address - Country:US
Practice Address - Phone:856-963-6333
Practice Address - Fax:856-963-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy