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General NPI Number Information
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NPI Number | 1770636649
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Entity Type | Organization
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Legal Business Name | LISS MEDICAL ARTS PHARMACY & SURGICAL INC.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 33 OVERLOOK RD SUITE 102
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City | SUMMIT
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State | NJ
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Zip | 07901-3570
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Country | US
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Telephone | 908-522-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 33 OVERLOOK RD SUITE 102
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City | SUMMIT
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State | NJ
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Zip | 07901-3570
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Country | US
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Telephone | 908-522-0111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KUNAL S SHAH
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Credential |
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Telephone | 908-522-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RS04882
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License Number State | NJ
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