Madison Ave Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28RS00721100 Issued in NJ

Legal business name

MADISON AVE PHARMACY LLC

Practice address

400 Madison Ave
Lakewood, NJ 08701-3225

Phone

(732) 370-4200

Fax

(732) 328-2233

NPI assigned

Aug 23, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Segal

Title

Owner

Phone

(908) 745-1020

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Madison Pharmacy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1345680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391040000000",
    "number": "1063760098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013225",
            "telephone_number": "732-370-4200",
            "fax_number": "732-328-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013225",
            "telephone_number": "732-370-4200",
            "fax_number": "732-328-2233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON AVE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-23",
        "last_updated": "2014-01-30",
        "status": "A",
        "authorized_official_last_name": "SEGAL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-745-1020"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NJ",
            "license": "28RS00721100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0366196",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2136670",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Laura Macalik, BA
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• Madison Infusion Center
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• Community/Retail Pharmacy in Lakewood, NJ
• Providers in Lakewood, NJ by specialty
• Community/Retail Pharmacy in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.