Fanwood RX Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28RS00749500 Issued in NJ

Legal business name

FANWOOD RX CORP

Practice address

45 S Martine Ave
Fanwood, NJ 07023-1216

Phone

(908) 680-6936

Fax

(908) 680-6937

NPI assigned

Jun 5, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Mitul P Patel, PHARMDNPI 1376827154

Title

Pharmacist in Charge

Phone

(908) 680-6936

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• Fanwood Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

Tax ID family

Fanwood Pharmacy2 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.

• Fanwood RX Corp

  • Long Term Care Pharmacy
  • Fanwood, NJ
  • NPI 1225901374
  NPD tax ID

Locations

Practitioners 2

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

• Mitul P Patel, PHARMD, RPH

  • Pharmacist
  • Fanwood, NJ
  • NPI 1376827154
  NPD Authorized official
• Tushar Jayantibhai Mistry, PHARM.D

  • Pharmacist
  • West Orange, NJ
  • NPI 1144942244
  NPD

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

{
    "created_epoch": "1465084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723680000000",
    "number": "1851740401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 TED LIGHT WAY",
            "city": "PISCATAWAY",
            "state": "NJ",
            "postal_code": "08854",
            "telephone_number": "848-228-9655",
            "fax_number": "908-680-6937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 S MARTINE AVE",
            "city": "FANWOOD",
            "state": "NJ",
            "postal_code": "070231216",
            "telephone_number": "908-680-6936",
            "fax_number": "908-680-6937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANWOOD RX CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-05",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "MITUL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "908-680-6936",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "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": "28RS00749500",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0547891",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160637",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fanwood Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fanwood Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fanwood Dental Associates, Inc.
• Fanwood Eye Care LLC
• Fanwood Family and Cosmetic Dentistry
• Fanwood Family Dental
• Fanwood RX Corp
• Fanwood Senior Care, LLC
• Jennifer C Feeney, DVM
• Theresa Fernandes, BCBA
• Lawrence Fleischman
• Faith E Galletley, BCBA

• Community/Retail Pharmacy in Fanwood, NJ
• Providers in Fanwood, 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 Aug 15, 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.