140 Main Street Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28RS00561000 Issued in NJ

Legal business name

140 MAIN STREET CORPORATION

Doing business as

campbell's pharmacy

Practice address

2175 Highway 35
Sea Girt, NJ 08750-1009

Phone

(732) 974-2929

Fax

(732) 974-2644

NPI assigned

Sep 20, 2006

Last updated

Nov 9, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Denis Campbell

Title

Owner

Phone

(732) 974-2929

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• campbell's pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

Tax ID family

140 Main Street Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 140 Main Street Corporation

  dba Campbell's Pharmacy

  • Long Term Care Pharmacy
  • Sea Girt, NJ
  • NPI 1316720790
  NPD tax ID

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1679670509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2175 HIGHWAY 35",
            "city": "SEA GIRT",
            "state": "NJ",
            "postal_code": "087501009",
            "telephone_number": "732-974-2929",
            "fax_number": "732-974-2644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2175 HIGHWAY 35",
            "city": "SEA GIRT",
            "state": "NJ",
            "postal_code": "087501009",
            "telephone_number": "732-974-2929",
            "fax_number": "732-974-2644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "140 MAIN STREET CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "DENIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-974-2929"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NJ",
            "license": "28RS00561000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7623313",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7623305",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2053955",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "campbell's pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Sea Girt, NJ
• Providers in Sea Girt, 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 Nov 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.