NPIMap

Organization Active NPI

Madura RX LLC

Doing business as Madura Pharmacy

  • Pharmacy
  • South Amboy, NJ
National Provider Identifier
1861867038
Registry record updated Sep 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
28RS00116700 Issued in NJ
Legal business name
MADURA RX LLC
Doing business as
Madura Pharmacy
Practice address
115 N Broadway
South Amboy, NJ 08879-1648
Phone
(732) 721-1732
Fax
(732) 553-7252
NPI assigned
Dec 14, 2015
Last updated
Sep 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2016

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

Authorized official

Name
Trupti PatelNPI 1114184256
Title
Pharmacist in Charge
Phone
(201) 674-2748

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 28RS00116700 NJ Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

115 N Broadway
South Amboy, NJ 08879-1648

Mailing address

115 N Broadway
South Amboy, NJ 08879-1648
Phone (732) 721-1732

Other identifiers 2

IdentifierTypeStateIssuer
2155951OtherPK
0522058MedicaidNJ

Other names 1

  • Madura Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160701001108 NJ DME Supplier - Pharmacy 0941592471 Practice locations: South Amboy, NJ
O20160728001233 NJ Part B Supplier - Mass Immunization (Roster Biller Only) 0941592471 Practice locations: South Amboy, NJ

National Provider Directory

National Provider Directory
Tax ID family
Madura 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.

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1450051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474588800000",
    "number": "1861867038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 N BROADWAY",
            "city": "SOUTH AMBOY",
            "state": "NJ",
            "postal_code": "088791648",
            "telephone_number": "732-721-1732",
            "fax_number": "732-553-7252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 N BROADWAY",
            "city": "SOUTH AMBOY",
            "state": "NJ",
            "postal_code": "088791648",
            "telephone_number": "732-721-1732",
            "fax_number": "732-553-7252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADURA RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-14",
        "last_updated": "2016-09-23",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "TRUPTI",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "201-674-2748"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NJ",
            "license": "28RS00116700",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2155951",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0522058",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madura Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Amboy, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2016; 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.