Boyds Pharmacy of Medford Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28RS00715400 Issued in NJ

Legal business name

BOYDS PHARMACY OF MEDFORD INC

Doing business as

Boyd's Pharmacy of Medford

Practice address

5 Wilkins Station Rd Ste 100
Medford, NJ 08055-9606

Phone

(609) 975-8197

Fax

(609) 975-8223

NPI assigned

Oct 10, 2011

Last updated

Oct 2, 2024By 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

Matthew Tootell

Title

Director of Operations

Phone

(609) 975-8197

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Boyd's Pharmacy of Medford Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

Tax ID family

Boyds Pharmacy of Medford Inc2 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.

• Boyds Pharmacy of Medford Inc

  • Long Term Care Pharmacy
  • Medford, NJ
  • NPI 1801619762
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marvin Wainwright Jr., R.PH.

  • Pharmacist
  • Medford, NJ
  • NPI 1295152759
  NPD (past)

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

{
    "created_epoch": "1318204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1710261730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 WILKINS STATION RD STE 100",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080559606",
            "telephone_number": "609-975-8197",
            "fax_number": "609-975-8223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 WILKINS STATION RD STE 100",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080559606",
            "telephone_number": "609-975-8197",
            "fax_number": "609-975-8223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYDS PHARMACY OF MEDFORD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-10",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A",
        "authorized_official_last_name": "TOOTELL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "609-975-8197"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NJ",
            "license": "28RS00715400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0286541",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2132262",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boyd's Pharmacy of Medford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Medford, NJ
• Providers in Medford, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.