Provider Demographics
NPI:1437908498
Name:WYATT'S TORCH
Entity type:Organization
Organization Name:WYATT'S TORCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:V
Authorized Official - Last Name:MINNITI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-786-9139
Mailing Address - Street 1:1201 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-3105
Mailing Address - Country:US
Mailing Address - Phone:856-963-4742
Mailing Address - Fax:856-541-8580
Practice Address - Street 1:1201 HADDON AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3105
Practice Address - Country:US
Practice Address - Phone:856-963-4742
Practice Address - Fax:856-541-8580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy