# MPS RX TRI-STATE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Millennium Pharmacy Systems Inc S
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164744546
- **Authorized official:** TERRI DELANY RPH (MANAGER, BUSINESS SYSTEMS SUPPORT)
- **Authorized official phone:** (201) 784-1643

## Contact information

- **Practice address:** 22 PARIS AVE, NORTHVALE, NJ 07647-2600
- **Practice address phone:** (201) 784-1643
- **Mailing address:** 22 PARIS AVE, NORTHVALE, NJ 07647-2600
- **Mailing address phone:** (201) 784-1643

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 28RS00701000 | NJ | — |
| 333600000X | Pharmacy | 28RS00701000 | NJ | — |
| 3336L0003X | Long Term Care Pharmacy | 28RS00701000 | NJ | Yes |

## Other

- **Enumeration date:** 02/25/2010
- **Last updated:** 03/02/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | PENDING | MEDICARE & MEDICAID PENDING | — |