Healthcare Provider Details

I. General information

NPI: 1689588030
Provider Name (Legal Business Name): PROVESSARX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 SPRING ST STE 103C
NEW PROVIDENCE NJ
07974-1143
US

IV. Provider business mailing address

41 SPRING ST STE 103C
NEW PROVIDENCE NJ
07974-1143
US

V. Phone/Fax

Practice location:
  • Phone: 866-776-6782
  • Fax:
Mailing address:
  • Phone: 866-776-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHEN LARIVIERE
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 866-776-6782