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General NPI Number Information
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NPI Number | 1477925576
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Entity Type | Organization
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Legal Business Name | MEDICAL TECHNOLOGY PHARMACY
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 54 MAIN ST
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City | BLOOMINGDALE
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State | NJ
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Zip | 07403-1630
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Country | US
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Telephone | 201-881-8281
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 134
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City | BLOOMINGDALE
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State | NJ
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Zip | 07403-0134
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Country | US
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Telephone | 201-881-8281
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. MICHAEL NESTICO
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Credential | RPH
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Telephone | 201-602-4512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 28RS00744800
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License Number State | NJ
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