Active NPI
Robert Jay Bodine, RPH
- Pharmacist
- Lakehurst, NJ
National Provider Identifier
1023323425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RI01581700
- Practice address
- 19 Union Ave
Lakehurst, NJ 08733-3023 - Phone
- (732) 657-6521
- Fax
- (732) 657-1625
- NPI assigned
- Aug 11, 2010
- Last updated
- Aug 11, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RI01581700 | NJ | Primary |
Addresses
Primary practice location
19 Union Ave
Lakehurst, NJ 08733-3023
Mailing address
165 Brandon Rd
Manchester, NJ 08759-6244
Phone (732) 657-1989
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6720102 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI01581700 | NJ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281484800000",
"number": "1023323425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 BRANDON RD",
"city": "MANCHESTER",
"state": "NJ",
"postal_code": "087596244",
"telephone_number": "732-657-1989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 UNION AVE",
"city": "LAKEHURST",
"state": "NJ",
"postal_code": "087333023",
"telephone_number": "732-657-6521",
"fax_number": "732-657-1625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODINE",
"first_name": "ROBERT",
"middle_name": "JAY",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-11",
"last_updated": "2010-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI01581700",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6720102",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakehurst, NJ
- Omar Amer, DPT, PT
- Mark Immanuel Auerbach, DPT
- Beacon of Life Central NJ (BoldAge PACE Central NJ)
- Board of Education, Lakehurst
- Branch Medical Clinic Lakehurst
- Brian S Klohn DMD PA (Lakehurst Dental)
- April Michelle Chillemi, LCSW
- Community Infusion Services, LLC (Vital Care of Toms River)
- Comsti Deperio Pineda and Associates LLC (Physicians for Adults)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.