1356154769 NPI number — PATIENT FRIENDLY SPECIALTY PHARMACY -PFSP

Table of content: (NPI 1356154769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356154769 NPI number — PATIENT FRIENDLY SPECIALTY PHARMACY -PFSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATIENT FRIENDLY SPECIALTY PHARMACY -PFSP
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:
1356154769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
539 VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTCLAIR
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07043-3814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-666-0333
Provider Business Mailing Address Fax Number:
877-274-3727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
539 VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07043-3814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-666-0333
Provider Business Practice Location Address Fax Number:
877-274-3727
Provider Enumeration Date:
01/29/2025

Additional Information

Authorized Official

Authorized Official Last Name:
GUTTMAN
Authorized Official First Name:
JESSE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
908-666-0333

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com