Provider Demographics
NPI:1730787938
Name:BONHAMTOWN PHARMACY LLC
Entity type:Organization
Organization Name:BONHAMTOWN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANKUR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-494-3916
Mailing Address - Street 1:2853 WOODBRIDGE AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837
Mailing Address - Country:US
Mailing Address - Phone:732-605-4307
Mailing Address - Fax:732-605-4308
Practice Address - Street 1:2853 WOODBRIDGE AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837
Practice Address - Country:US
Practice Address - Phone:732-605-4307
Practice Address - Fax:732-605-4308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy