MYSTIC PHARMACY INC (NPI# 1083752216) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083752216 |
| Entity Type | Organization |
| Organization Name | MYSTIC PHARMACY INC |
| Practice Address |
972 Radio Rd Little Egg Harbor NJ 08087 |
| Practice Telephone | 6092960934 |
| Practice Fax Number | 6092966250 |
| Mailing Telephone | 6092960934 |
| Mailing Fax Number | 6092966250 |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. JOHN MICHAEL WARD (PHARMACIST IN CHARGE) |
| Authorized Official Telephone | 6092960934 |
| Authorized Official Credential | RP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 333600000X | Pharmacy | 28RS00391800 | NJ | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | 4337905 | 05 |
| Street Address |
972 RADIO RD |
| City | LITTLE EGG HARBOR |
| State | NJ |
| Zip Code | 08087 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932610300 | Acme Markets Inc | Durable Medical Equipment & Medical Supplies | 425 Us 9, Tuckerton, NJ 08087 | 2017-10-12 |
| 1679083877 | Tiffany Wild | Speech-Language Pathologist | 324 Frog Pond Rd, Little Egg Harbor Township, NJ 08087 | 2017-10-03 |
| 1124570098 | Dana Nicole Luciano | Physician Assistant | 798 County Road #539, #3, Little Egg Harbor Township, NJ 08087 | 2016-10-26 |
| 1235598616 | Ocean Health Initiatives,inc | General Practice | 798 County Road 539, Little Egg Harbor, NJ 08087 | 2016-02-15 |
| 1093159253 | Terraces At Seacrest Village LLC | Assisted Living Facility | 281 Mathistown Road, Little Egg Harbor Township, NJ 08087 | 2013-04-18 |
| 1023390762 | Gerri Hoegler | Counselor | 1064 S. Main St. Unit 206, West Creek, NJ 08087 | 2011-09-19 |
| 1437366572 | Walgreens Pharmacy | Pharmacy | 201 Mathistown Road, Little Egg Harbor, NJ 08087 | 2007-05-17 |
| 1669599957 | Paul Damian Lauria | Chiropractor | 871 Radio Rd, Little Egg Harbor, NJ 08087 | 2007-03-23 |
| 1528196276 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 201 Mathistown Rd, Little Egg Harbor Twp, NJ 08087 | 2007-03-02 |
| 1326134263 | Ronald P Petrosky | Dentist | 210 Great Bay Blvd, Tuckerton, NJ 08087 | 2006-10-05 |
| Find all providers in zip 08087 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801495544 | Medilink Rxcare Hammonton, LLC | Pharmacy | 44 S White Horse Pike, Hammonton, NJ 08037-1845 | 2020-10-23 |
| 1770193757 | Rvl Pharmacy | Pharmacy | 2500 Main St Ste 10, Sayreville, NJ 08872-1473 | 2020-08-05 |
| 1043828577 | Siddhivinayak Inc. | Pharmacy | 90 Bergen St # 1600, Newark, NJ 07103-2425 | 2020-07-21 |
| 1891303616 | Amwell Pharmacy Inc. | Pharmacy | 438 Route 206 Ste 3, Hillsborough, NJ 08844-5525 | 2020-07-17 |
| 1366066235 | Brx LLC | Pharmacy | 250 Chambers Bridge Rd, Brick, NJ 08723 | 2020-06-05 |
| 1982237103 | Holmdel Pharmacy and Deli LLC | Pharmacy | 487 Middle Rd, Hazlet, NJ 07730-2426 | 2020-02-17 |
| 1184254575 | Frrx LLC | Pharmacy | 76 W Gilbert St, Tinton Falls, NJ 07701-4918 | 2020-01-24 |
| 1841820388 | Ewing Pharmacy LLC | Pharmacy | 1400 Parkway Ave Ste A2, Ewing, NJ 08628-3021 | 2020-01-23 |
| 1982240735 | Elite Rx LLC | Pharmacy | 2282 Hamburg Tpke Ste E, Wayne, NJ 07470-6291 | 2019-11-26 |
| 1629626163 | Meadowlands Pharmacy LLC | Pharmacy | 40, Meadowlands Pkway, Secaucus, NJ 07094 | 2019-08-28 |
| Find all providers with the same taxonomy | ||||
| City | LITTLE EGG HARBOR |
| Zip Code | 08087 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.