1063923571 NPI number — MORRIS PLAINS PHARMACY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063923571 NPI number — MORRIS PLAINS PHARMACY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORRIS PLAINS PHARMACY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063923571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
712 SPEEDWELL AVE, 1ST FLOOR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRIS PLAINS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-539-3635
Provider Business Mailing Address Fax Number:
973-539-8447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
712 SPEEDWELL AVE
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
MORRIS PLAINS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-539-3635
Provider Business Practice Location Address Fax Number:
973-539-8447
Provider Enumeration Date:
10/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
VAJINEPALLI
Authorized Official First Name:
SRIDEVI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-539-3635

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  28RS00399600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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