Organization
MT PROSPECT PHARMACEUTICAL SERVICES INC
Active
Other names
Liss Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW JOSEPH PARISI JR. (OWNER)
(973) 483-4749
Entity
Organization
Contact information
Practice address
794 MOUNT PROSPECT AVE, NEWARK, NJ 07104-3221
(973) 483-4749
(973) 482-0643
Mailing address
794 MOUNT PROSPECT AVE, NEWARK, NJ 07104-3221
(973) 483-4749
(973) 482-0643
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NJ
3336C0003X
Community/Retail Pharmacy
Primary
28RS00225300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2778009
—
NJ
01
—
3112620
NABP
NJ
05
—
4249305
—
NJ
Enumeration date
09/07/2006
Last updated
09/11/2017
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