Managua Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28RS00688300 Issued in NJ

Legal business name

MANAGUA INC

Doing business as

Family Pharmacy

Practice address

581 Blackwood Clementon Rd
Lindenwold, NJ 08021-5901

Phone

(856) 627-0004

Fax

(856) 627-2244

NPI assigned

Aug 18, 2006

Last updated

Jul 23, 2009By 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

Mohit Patel

Title

Front Store Manager

Phone

(856) 627-0004

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• FAMILY PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248307200000",
    "number": "1730293812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "581 BLACKWOOD CLEMENTON RD",
            "city": "LINDENWOLD",
            "state": "NJ",
            "postal_code": "080215901",
            "telephone_number": "856-627-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "581 BLACKWOOD CLEMENTON RD",
            "city": "LINDENWOLD",
            "state": "NJ",
            "postal_code": "080215901",
            "telephone_number": "856-627-0004",
            "fax_number": "856-627-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANAGUA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2009-07-23",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "MOHIT",
        "authorized_official_title_or_position": "FRONT STORE MANAGER",
        "authorized_official_telephone_number": "856-627-0004"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NJ",
            "license": "28RS00688300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3144401",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mikyung Lee, LAC
• Lindenwold Board of Education
• Lindenwold Board of Education
• Philip John Maceno III, RPH
• Robert Maddred, LPN
• Michael Joseph Matricciano Jr., PHARMD
• Elon McCain
• Jason Paul McCarthy
• Colleen M McCleery, M.D.
• Kima McGee

• Community/Retail Pharmacy in Lindenwold, NJ
• Providers in Lindenwold, 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 Jul 23, 2009; 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.