Healthcare Provider Details

I. General information

NPI: 1356154769
Provider Name (Legal Business Name): PATIENT FRIENDLY SPECIALTY PHARMACY -PFSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 VALLEY RD
MONTCLAIR NJ
07043-3814
US

IV. Provider business mailing address

539 VALLEY RD
MONTCLAIR NJ
07043-3814
US

V. Phone/Fax

Practice location:
  • Phone: 908-666-0333
  • Fax: 877-274-3727
Mailing address:
  • Phone: 908-666-0333
  • Fax: 877-274-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JESSE GUTTMAN
Title or Position: PHARMACIST
Credential:
Phone: 908-666-0333