Provider Demographics
NPI:1881417749
Name:BOYD'S PHARMACY OF PEMBERTON, INC.
Entity type:Organization
Organization Name:BOYD'S PHARMACY OF PEMBERTON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:TOOTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-894-1679
Mailing Address - Street 1:17 FORT DIX RD
Mailing Address - Street 2:
Mailing Address - City:PEMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08068-1439
Mailing Address - Country:US
Mailing Address - Phone:609-894-8288
Mailing Address - Fax:609-894-2225
Practice Address - Street 1:17 FORT DIX RD
Practice Address - Street 2:
Practice Address - City:PEMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08068-1439
Practice Address - Country:US
Practice Address - Phone:609-894-8288
Practice Address - Fax:609-894-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy