Provider Demographics
NPI:1184924516
Name:KINGSWAY PHARMACY LLC
Entity type:Organization
Organization Name:KINGSWAY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:UGWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-448-3702
Mailing Address - Street 1:55 SHIPPEN RDG
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07863-3238
Mailing Address - Country:US
Mailing Address - Phone:908-453-3692
Mailing Address - Fax:908-453-3636
Practice Address - Street 1:135 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828-2514
Practice Address - Country:US
Practice Address - Phone:973-448-3702
Practice Address - Fax:973-448-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007086003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3197438OtherNCPDP PROVIDER IDENTIFICATION NUMBER