Healthcare Provider Details

I. General information

NPI: 1538100441
Provider Name (Legal Business Name): MORRIS PLAINS PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 SPEEDWELL AVE
MORRIS PLAINS NJ
07950-2269
US

IV. Provider business mailing address

712 SPEEDWELL AVE
MORRIS PLAINS NJ
07950-2269
US

V. Phone/Fax

Practice location:
  • Phone: 973-539-3635
  • Fax: 973-539-8447
Mailing address:
  • Phone: 973-539-3635
  • Fax: 973-539-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00399600
License Number StateNJ

VIII. Authorized Official

Name: SRIDEVI VAJINEPALLI
Title or Position: PRESIDENT
Credential:
Phone: 973-539-3635