Medicine Man RX LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28RS00722900 Issued in NJ

Legal business name

MEDICINE MAN RX LLC

Doing business as

Medicine Man Pharmacy & Compounding

Practice address

511 Washington St
Hoboken, NJ 07030-4993

Phone

(201) 942-9777

Fax

(201) 942-9779

NPI assigned

Nov 16, 2012

Organization subpart

No

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

Authorized official

Name

Pankit Sutaria

Title

President

Phone

(201) 942-9777

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Medicine Man Pharmacy & Compounding Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Akta M Patel

  • Pharmacist
  • Hoboken, NJ
  • NPI 1073101598
  NPD (past)
• Mohannad Siyam, RPH

  • Pharmacist
  • Union City, NJ
  • NPI 1699299479
  NPD (past)
• Bino Chandy, RPH

  • Pharmacist
  • Woodside, NY
  • NPI 1245807643
  NPD (past)

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

{
    "created_epoch": "1353024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1598009383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 WASHINGTON ST",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070304993",
            "telephone_number": "201-942-9777",
            "fax_number": "201-942-9779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 WASHINGTON ST",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070304993",
            "telephone_number": "201-942-9777",
            "fax_number": "201-942-9779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE MAN RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-16",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A",
        "authorized_official_last_name": "SUTARIA",
        "authorized_official_first_name": "PANKIT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-942-9777"
    },
    "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": "28RS00722900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0383911",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2153660",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicine Man Pharmacy & Compounding",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Erin McGrath
• Christopher Joseph McNamara, M.D.
• Shannon Ohern McNamara, MD
• George E. McQuilkin, M.D.
• John Mead, MD
• Courtney Medina
• Judith Meer, PT, DPT, CSCS
• Harendra Umangla Mehta, M.D.
• Harshna Mehta, M.D.
• Ragini Mehta, D.O.

• Community/Retail Pharmacy in Hoboken, NJ
• Providers in Hoboken, 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 Oct 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.