Provider Demographics
NPI:1487710364
Name:WALD DRUGS 2 FLEMINGTON
Entity type:Organization
Organization Name:WALD DRUGS 2 FLEMINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARM
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD AND PHD
Authorized Official - Phone:908-782-2224
Mailing Address - Street 1:37 REAVILLE AVE
Mailing Address - Street 2:HUNTERDON SC
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 REAVILLE AVE
Practice Address - Street 2:HUNTERDON SC
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1714
Practice Address - Country:US
Practice Address - Phone:908-788-3780
Practice Address - Fax:908-788-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00524700333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6850502Medicaid
3137684OtherOTHER ID NUMBER-COMMERCIAL NUMBER