MEDICARE: PRESCRIPTION DYNAMICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy

General Provider Information

NPI Number	:	1720368491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCRIPTION DYNAMICS

Provider Business Mailing Address
First Line	:	85 CHESTNUT RIDGE RD
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1827
Country	:	US
Telephone Number	:	914-419-3010
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 CHESTNUT RIDGE RD
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1827
Country	:	US
Telephone Number	:	914-419-3010
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL DE GIGLIO
Credential	:	RPH
Telephone Number	:	914-419-3010

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	08/25/2011

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