=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639698517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GSP PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 90 WASHINGTON ST
-----------------------------------------------------
City | EAST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07017-1050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-676-0800
-----------------------------------------------------
Fax | 973-676-1408
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 90 WASHINGTON ST
-----------------------------------------------------
City | EAST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07017-1050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-676-0800
-----------------------------------------------------
Fax | 973-676-1408
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MR. PINAL PATEL
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 973-676-0800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 28RS00653400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------